ii      li  I   i, 


Jijt 

III  .' 


I         i!!' 


till 


mW^- 


i 


iii'',!iiii:i! 

,.,,... 


lliliiiiiililiiiiiiiiiiiiiiiii 


'''''" i'iiiiiiiiiiiii 


UCt  ECM  LIBRARY 


CALIFORNIA  COLLEGE  OF  MEDICINE 


THE 

MEDICAL  TREATMENT 

OF 

CANCER 


BY  THE  SAME  AUTHOR 

CANCER,  ITS  CAUSE  AND  TREATMENT.  Vol.  I. 
$1.50  net. 

CANCER,  ITS  CAUSE  AND  TREATMENT.  Vol.  II. 
$1.60  net. 

DIET  AND  HYGIENE  IN  DISEASES  OF  THE 
SKIN.  $2.00  net. 

COMPENDIUM  OF  DISEASES  OF  THE  SKIN,  based 
on  an  analysis  of  thirty  thousand  consecutive  cases, 
with  a  Therapeutic  Formulary.   $2.00. 

THE  RELATIONS  OF  DISEASES  OF  THE  SKIN 
TO  INTERNAL  DISORDERS.    $1.50. 

PRINCIPLES  AND  APPLICATION  OF  LOCAL 
TREATMENT    IN   DISEASES   OF   THE    SKIN. 

$1.00. 

THE  INFLUENCE  OF  THE  MENSTRUAL  FUNC- 
TION ON  CERTAIN  DISEASES  OF  THE  SKIN. 

$1.00. 

ECZEMA,  with  an  analysis  of  eight  thousand  cases  of 
the  disease.   $1.25. 

ACNE,  ITS  ETIOLOGY,  PATHOLOGY,  AND  TREAT- 
MENT.   $2.00. 

SYPHILIS  IN  THE  INNOCENT  (Syphilis  insontium), 
clinically  and  historically  considered,  with  a  plan  for 
the  legal  control  of  the  disease.    $3.00. 

ACNE  AND  ALOPECIA.  The  Physician's  leisure  li- 
brary.    Fifty  cents. 

THE  SKIN  IN  HEALTH  AND  DISEASE.  Fifty 
cents. 

THE  USE  AND  ABUSE  OF  ARSENIC  IN  THE 
TREATMENT   OF   DISEASES   OF   THE   SKIN. 

Fifty  cents. 

ARCHIVES  OF  DERMATOLOGY.  A  quarterly  Jour- 
nal of  Skin  and  Venereal  Diseases.  Vols.  I-VIII. 
$3.00  each. 


THE 

MEDICAL   TREATMENT 

OF 

CANCER 


BY 
L.  DUNCAN  BULKLEY,  A.M.,  M.D. 

Senior  Physician  to  the 
New  York  Skin  and  Cancer  Hospital,  etc. 


PHILADELPHIA 

F.  A.  DAVIS  COMPANY,  Publishers 

english  depot 

Stanley  Phillips,  London 

1919 


Copyright,  1919 
F.  A.  DAVIS  COMPANY 


Copyright  Great  Britain 
All  rights  reserved 


X)"  ^// 


To 
THE  GOVERNORS 

of  the 

NEW    YORK    SKIN    AND    CANCER    HOSPITAL 

Whose  kind  appreciation  of  and  assistance  to  the  author 
in  his  clinical  work  in  their  institution  have 
done  much  to  encourage  him  and  to 
promote  the  interest  of  the  pro- 
fession in  the  branches  of 

DERMATOLOGY 

and 

CANCER 

this  volume  is 
inscribed 


"MEDICINE  TO  SUPPLANT  KNIFE." 

New  York  Sun,  November  17,  1913. 
Dr.  J.  B.  Murphy,  of  Chicago,  Says 
25  Years  Will  Fixd  Drugs  in  Lead. 
Chicago,   Nov.    16. — Internal   medicine   will   take   pre- 
cedence over  surgery  for  the  next  twenty-five  years,  is 
the  belief  of  Dr.  John  B.  Murphy,  one  of  the  foremost 
surgeons  of  America.    He  expressed  this  view  before  the 
Congress  of  Clinical  Surgeons,  following  his  election  as 
President  of  the  organization. 

"It  is  internal  medicine,"  he  said,  "that  goes  into  the 
details,  and  the  advance  in  it  in  the  next  quarter  cen- 
tury will  be  greater  than  the  advance  in  surgery.  If  I 
were  to  start  over  again  I  would  start  in  internal  medi- 
cine, because  its  possibilities  are  unlimited." 

Seeing  the  above  in  the  morning  paper,  I  sent  it  to  Dr. 
Murphy  and  asked  him  if  it  was  true,  remarking  that  if 
it  was  so  I  wanted  to  congratulate  him  and  humanity. 

His  reply  follows:  November  26,  1913. 

Dr.  L.  Duncan  Bulkley, 

681  Madison  Avenue,  New  York  City. 
Dear  Doctor: 

In  reply  to  your  letter  of  the  17th,  I  would  say  that 
the  press  report  was  correct  as  to  the  essential  details. 
Internal  medicine  offers  unquestionably  greater  opportu- 
nities to-day  than  does  surgery,  and  if  the  same  amount 
of  labor,  energy  and  skill  were  exercised  in  the  inter- 
nal medicine  line  as  is  exercised  in  surgery,  I  feel  that 
greater  results  could  be  accomplished.  I  feel  that  inter- 
nal medicine  is  a  field  for  wholesale  achievements,  while 
surgery  will  of  necessity  always  be  retail  work.  Further- 
more, a  survey  of  the  possibilities  of  the  future  in  the 
way  of  diagnosis,  early  recognition  and  treatment  should 
offer  enormously  more  in  the  way  of  rewards  to  the  peo- 
ple and  the  profession  than  the  surgery  of  the  next  two 
decades,  as  far  as  we  are  able  to  judge  from  present 
viewpoints. 

I  wish  to  thank  you  for  your  letter  and  to  say  that  it 
has  been  the  work  of  many  of  your  class  that  has  stimu- 
lated me  to  greater  endeavors  and  aided  me  in  my  work. 

With  expression  of  esteem  and  highest  regard,  I  am, 
dear  doctor.  Sincerely  yours, 

(Signed)  J.  B.  Murphy. 


PEEFACE 

Cancer  is  still  a  pressing  problem.  Ac- 
cording to  the  latest  report  of  the  Mortal- 
ity Tables  of  the  United  States  the  death 
rate  has  continued  to  rise  steadily  and  la- 
mentably, in  spite  of  assiduous  and  faith- 
ful work  in  the  laboratories,  and  arduous 
and  intelligent  efforts  of  skilled  surgeons, 
who  have  also  made  a  strenuous  propa- 
gandism  in  regard  to  the  necessity  of 
early  and  complete  extirpation. 

In  my  former  volumes  I  have  endeav- 
ored to  present  the  reason  why  with  this 
method  of  simply  removing  the  products 
of  the  disease,  the  offending  tumors,  with 
the  knife,  we  cannot  expect  to  eradicate 
cancer  which,  as  we  know,  affects  the 
whole  system,  and  in  the  end  causes  the 
death  of  ninety  per  cent,  of  those  once  at- 
tacked. It  is  understood  that  this  does 
7 


8  PREFACE 

not  refer  to  epithelioma  of  the  cutaneous 
surface,  but  to  true  cancer,  affecting  inter- 
nal organs. 

In  former  volumes  I  have  also  endeav- 
ored, as  far  as  possible,  to  present  the 
medical  aspects  of  cancer,  the  systemic 
conditions  which  are  at  fault,  and  the 
measures,  dietary  and  other,  whereby  they 
can  be  corrected  and  the  disease  con- 
trolled, giving  illustrative  cases,  out  of 
many  others,  in  which  this  has  been  fol- 
lowed by  the  disappearance  of  the  offend- 
ing tumor. 

It  is  very  satisfactory  that  the  audi- 
ences of  physicians  whom  I  have  ad- 
dressed, and  the  medical  journals,  have 
received  the  new  doctrine  so  favorably, 
and  rarely  have  there  been  any  adverse 
criticisms.  Many  letters  have  also  come 
from  physicians  in  this  country  and  else- 
where, sustaining  my  claims  and  mention- 
ing cases  verifying  the  same.  But  the  sur- 
geons seem  still  to  hold  to  their  precon- 
ceived ideas.    When  the  first  volume  ap- 


PREFACE  9 

peared  a  surgeon  remarked  that  so  small 
a  volume  could  not  effect  anything  in 
changing  the  universal  opinion  in  regard 
to  cancer.  I  asked  him  if  he  had  ever 
seen  an  acorn,  and  remarked  that  if  I 
planted  an  acorn,  and  left  it  unprotected 
in  an  open  field  where  there  were  some 
bulls  I  might  not  expect  to  grow  an  oak, 
but  by  hedging  it  around  until  the  oak  was 
fully  grown,  I  should  then  expect  the  tree 
to  take  care  of  itself  and  be  a  blessing. 
It  is  gratifying  to  observe  that  this  has 
in  a  measure  happened,  and  that  there  is 
a  widespread  interest  in  the  subject  which 
has  been  so  often  presented,  and  a  grad- 
ual acceptance,  by  many,  of  the  principles 
involved.  It  takes  time  for  all  new  ideas 
to  be  adopted,  whether  in  medicine,  sci- 
ence, mechanics,  arts,  or  politics.  A  lead- 
ing medical  editor  to  whom  I  offered  a 
rather  radical  article  on  cancer  accepted 
it  at  once,  adding  in  his  letter,  ''It  is 
hard  to  overthrow  entrenched  error  with 
gentle  words." 


10  PREFACE 

As  the  journalistic  reviews  of  my  sec- 
ond little  book  have  been  so  encouraging 
I  venture  to  put  forth  another,  a  third 
acorn,  in  the  hopes  that  it  may  excite 
further  interest  in  this  most  important 
subject,  and  lead  others  to  investigate  the 
matter  and  to  report  their  experience  and 
cases  along  the  lines  indicated.  I  should 
also  be  glad  of  just  criticisms  on  a  sci- 
entific basis.  It  is  not  a  little  remarkable 
that  during  the  past  year  or  so  there  has 
been  such  a  singular  dearth  of  surgical 
articles  on  cancer,  as  a  careful  search 
of  literature  shows,  and  so  many  journal 
articles,  editorial  and  other,  looking 
toward  the  thoughts  on  cancer  which  I 
have  endeavored  to  present.  It  is  sin- 
cerely to  be  hoped  that  this  ratio  will  in- 
crease more  and  more,  and  we  shall  soon 
see  a  radical  diminution  in  the  death  rate  of 
cancer,  which  is  so  longed  for  by  all. 

There  are  encouraging  signs  of  this  al- 
ready, in  the  remarkable  diminution  of 
deaths  from  cancer  in  New  York  City,  as 


PREFACE  11 

shown  in  Chapter  IV,  on  the  cancer  death 
rate  there  during  1918;  there  has  also 
been  a  slight  decline  of  the  same  through- 
out the  United  States  in  1917. 

Most  of  the  material  in  this  third  vol- 
ume on  **The  Medical  Treatment  of 
Cancer'*  has  been  delivered  before  differ- 
ent medical  societies,  in  a  number  of  the 
States  in  the  Union,  and  much  of  it  has 
already  appeared  in  various  medical  jour- 
nals. It  has  been  thought  best  to  collect 
it  in  one  volume  for  reference,  inasmuch 
as  some  subjects  are  considered  which 
were  not  included  in  the  former  volumes, 
and  certain  subjects  are  developed  more 
fully  than  was  possible  in  the  lectures 
composing  the  former  volumes.  These 
latter  are  necessary  to  a  complete  under- 
standing of  the  facts  concerning  the  metab- 
olism and  systemic  changes  in  cancer, 
upon  which  the  whole  thesis  is  based. 
The  bibliographical  references  to  the 
names  here  mentioned  appear  at  the  end 
of  the  first  volume. 


12  PREFACE 

There  will  consequently  be  found  in 
this  volume  considerable  repetition  of 
facts  and  figures  previously  given,  which, 
however,  may  suffice  to  more  fully  impress 
those  here  and  previously  presented,  and 
to  lead  to  further  thought  and  study  of 
the  important  questions  involved,  as  to 
'*The  real  cancer  problem*'  and  the  most 
satisfactory  treatment  of  the  disease,  and 
its  prevention.  Some  one  has  said  that 
it  was  necessary  to  repeat  a  new  idea  five 
times.  First,  because  one  does  not  hear; 
second,  because  he  gives  no  attention; 
third,  because  he  does  not  understand; 
fourth,  because  he  does  not  believe:  So 
the  fifth  repetition  is  necessary  in  order 
to  make  a  real  and  effectual  impression. 

L.  Duncan  Bulkley. 

JANUABY    1.   1919. 

531  Madison  Ave. 


CONTENTS 


PAQE 

Preface        7 

CHAPTER  I 
A  Plea  fob  the  Rational  Tbeatment  of  Ganceb      15 

CHAPTER  II 

CaNCEB  as   a   NoN-SUBGICAL   DliEASE  .  .  25 

CHAPTER  III 

Canceb  Death  Rate  in  New  Yobk  City  Dubing 

1917 41 

CHAPTER  IV 

Canceb  Death  Rate  in  New  Yobk  City  Dubino 

1918 49 

CHAPTER  V 
Canceb  fbom  a  Medical  Standpoint         .         .       53 

CHAPTER  VI 
Medical  Aspects  of  Canceb        ....      71 

CHAPTER  VII 
The  Relation  of  Diet  to  Canceb        .        .        .     121 

CHAPTER  VIII 
Dietetic  and  Medical  Tbeatment  of  Canceb      .     144 


CHAPTER  IX 
NoN-SuEoiCAL  Treatment  of  Cancer    .  .  .     169 

CHAPTER  X 
Pathology  of  Canceb        .....     181 

CHAPTER  XI 
Medical  Treatment  of  Cancer    ....     211 

CHAPTER  XII 
Pbecancebous  Conditions         ....     248 

CHAPTER  XIII 
Body  Elimination  in  Cancer      ....     262 

CHAPTER  XIV 
Cancer  and  Civilization         ....    276 

CHAPTER  XV 
Cabcinoma  of  the  Buccal  Cavity        .        .        .     289 


CHAPTER  XVI 

What   Should  the   Genebal   Pbactitioneb  Do 

About   Canceb?         .  .  .         .  .     307 


CHAPTER  XVII 
Conclusions  and  Results         ....     321 


THE  MEDICALTREATMENT 
OF  CANCER 

CHAPTER  I 

A    PLEA    FOB    THE    RATIONAL    TREATMENT    OF 
CANCER 

Many  cases  of  undoubted  cancer,  both 
primary  and  recurrent  after  operation,  are 
on  record  which  have  disappeared  entirely 
and  remained  absent  under  a  complete 
change  of  diet  and  mode  of  life,  with  more 
or  less  of  proper  medical  treatment.  Mul- 
titudes of  cases  are  known  everywhere  in 
whom  the  disease  has  recurred,  with  ter- 
rible severity  and  death,  even  after  the 
most  complete  removal,  by  the  most  com- 
petent surgeons,  of  very  early  lesions  di- 
agnosed as  cancer,  some  of  which  proved 
to  be  only  adenoma,  microscopically. 
15 


16  MEDICAL  ASPECTS  OF  CANCER 

The  enormous  mass  of  laboratory  stud- 
ies which  have  been  recorded  has  added 
thus  far  very  little  to  our  knowledge  of 
the  real  nature  and  cause  of  cancer,  and 
really  nothing  to  treatment,  except  to  ad- 
vocate the  surgeon's  claim  of  the  right 
to  remove  instantly  everything  suspected 
to  be  cancer  or  ^ '  precancerous ' ' !  Surgery 
has  striven,  more  and  more  actively  of 
late  years,  to  stem  the  rising  tide  of 
mortality  from  cancer,  but,  alas !  the  Mor- 
tality Tables  of  the  United  States  show 
the  futility  of  this  means,  for  the  death 
rate  from  this  disease  has  risen  almost 
30  per  cent,  from  1900  to  1917. 

Laboratory  researches  have  rendered, 
however,  a  valuable  service  in  connection 
with  cancer,  by  the  negative  results  ob- 
tained, so  that  the  ground  is  pretty  well 
cleared  for  a  proper  understanding  of  the 
real  nature  and  cause  of  the  disease. 
Thus,  all  are  pretty  well  agreed  that  can- 
cer is  not  due  to  a  parasite,  nor  conta- 
gious, that  it  is  not  strongly  hereditary, 


RATIONAL  TREATMENT        17 

nor  due  wholly  to  local  irritant  action, 
that  it  is  not  altogether  a  disease  of  old 
age,  nor  belonging  to  any  particular  occu- 
pation, and  that  it  does  not  affect  any 
special  sex,  race,  or  class  of  persons :  can- 
cer exists  all  over  the  earth,  but  with  strik- 
ing differences  in  frequency,  according  to 
certain  peculiarities  in  diet  and  mode  of 
living,  associated  with  advancing  civiliza- 
tion. 

The  exclusion  of  the  various  suspected 
causes  of  cancer  by  the  prolonged  study 
of  many  trained  laboratory  and  other 
workers  along  the  lines  mentioned  leads 
the  thoughtful  person  to  inquire  if  there 
is  not  still  some  line  of  possible  etiology 
which  has  not  yet  been  fully  explored ;  for 
assuredly  there  is  some  actual,  physical 
cause  for  the  aberrant  action  of  originally 
normal  tissue  cells,  which  we  call  cancer. 
There  is  nothing  mysterious  about  the  dis- 
ease, except  that  thus  far  its  real  cause 
has  eluded  laboratory  workers;  but  many 
clinical  workers  have  long  suspected  and 


18  MEDICAL  ASPECTS  OF  CANCER 

suggested  one  without  much,  if  any,  effect 
on  the  profession,  so  enamored  has  it  be- 
come of  surgery,  and  so  insistent  and  loud 
have  been  the  claims  for  a  wholly  local 
origin  and  nature  of  th*  disease. 

But  the  failure  of  surgery  to  make  any 
appreciable  beneficial  impression  on  the 
morbidity  and  mortality  of  cancer,  as  al- 
ready mentioned,  and  the  exclusion  of  all 
other  possible  causes,  naturally  leads  us 
to  look  to  a  faulty  metabolism,  which  has 
to  do  with  such  a  multitude  of  other 
human  ailments ;  and  the  deeper  we  search 
the  laboratory  and  other  studies  which 
have  been  made  regarding  this,  the  more 
clear  does  it  appear  that  it  is  along  these 
lines  we  shall  find  the  true  means  for  the 
prevention  and  cure  of  cancer. 

It  is  impossible  in  a  brief  article  to  pre- 
sent the  evidence  in  which  this  statement 
is  founded,  which  has  been  developed 
pretty  fully  elsewhere,*  and  it  must  suffice 


♦  Bulkley — Cancer :  Its  Cause  and  Treatment,  Vole. 
I    and   II    Hoeber,    New   York,   1915,    1917. 


EATIONAL  TREATMENT        19 

to    concisely    state    the    principal    points. 

Cancer  has  been  found  definitely  to  in- 
crease with  the  spread  of  modern  so- 
called  civilization  along  the  lines  of  lux- 
ury and  attending  indolence.  This  has 
been  observed  especially  in  the  over-con- 
sumption of  meat,  coffee,  and  alcohol,  as 
proven  by  statistics. 

Many  have  recorded  changes  in  the 
urine  which  indicate  imperfect  metabolism, 
especially  of  nitrogenous  matter.  Careful 
daily  studies  of  the  urine,  both  in  the 
very  earliest  stages  of  cancer  and  late  in 
the  disease,  show  a  very  marked  failure 
of  elimination  by  this  excretion,  the  solids 
being  often  not  one-half  of  that  called  for 
by  the  body  weight  of  the  individual. 
Careful  observation  will  also  detect  a 
great  failure  in  intestinal  elimination,  in 
both  the  very  early  stages  of  the  disease 
and  all  through  its  course.  So  true  is 
this  that  Sir  Arbuthnot  Lane  has  declared 
that  cancer  may  be  one  of  the  late  results 
of  intestinal  stasis.     This  probably  oper- 


20  MEDICAL  ASPECTS  OF  CANCER 

ates  through  the  poisonous  action  devel- 
oped by  the  millions  of  micro-organisms 
formed  in  the  large  intestine,  indican 
being  not  an  infrequent  urinary  exhibit. 
It  has  been  shown  that  cholesterin  is  also 
an  important  element  in  connection  with 
the  genesis  of  cancer,  and  there  is  strong 
evidence  that  derangement  of  the  endocrin- 
ous glands  is  associated  with  the  produc- 
tion of   this   disease. 

It  is  quite  true  that  the  exact  metabolic 
disturbances,  or  the  actual  blood  state, 
inducing  and  perpetuating  cancer,  have 
not  as  yet  been  demonstrated,  and  perhaps 
they  never  will  be.  But  it  has  also  never 
been  shown  exactly  how  cancer  begins,  or 
when  a  benign  tissue  becomes  malignant, 
as  Ribert  has  said,  '^no  one  has  ever  seen 
the  beginnings  of  mammary  cancer  * ' :  both 
aspects  of  the  question,  the  constitutional 
and  the  local,  rest  on  clinical  grounds,  and 
not  a  shadow  of  proof  has  ever  been  pre- 
sented that  the  lump  which  we  call  cancer 
is  purely  local  in  character. 


RATIONAL  TREATMENT        21 

On  the  other  hand,  the  constant  ten- 
dency to  a  recurrence  of  the  disease  in  the 
same  or  other  locations,  even  after  the 
most  complete  removal  of  the  local  lesion 
and  surroundings,  and  the  continued  de- 
pression of  vitality  and  degeneration  of 
the  blood,  all  point  to  something  more 
than  a  local  disease;  they  all  show  a  con- 
stitutional cause  which  induced  the  orig- 
inal stasis  and  degenerative  action  of  tis- 
sue in  some  particular  locality  which  was 
unduly  irritated,  probably  the  site  of  an 
** embryonic  rest,''  that  is,  a  heterologous 
tissue  ready  to  revert  to  reproductive  life. 
This  latter  would  seem  to  be  the  starting- 
point,  inasmuch  as  the  tissues  in  general 
of  cancerous  subjects  heal  kindly,  and, 
after  injury  on  various  portions  of  the 
body,  there  is  little  or  no  tendency  to 
tumor  formation. 

Even  the  occurrence  of  metastases  ac- 
cords also  with  the  view  of  a  constitu- 
tional disorder.  For  after  surgical  oper- 
ation the  patient  is  invariably  left  uncared 


22  MEDICAL  ASPECTS  OF  CANCER 

for,  as  far  as  any  attempt  to  alter  the 
dyscrasic  condition  which  engendered  the 
disease,  and  very  naturally  the  transfer- 
ence of  cancerous  elements  by  the  blood 
or  lymph  stream  produces  a  local  condi- 
tion which  the  vitiated  blood  current  de- 
velops into  a  fresh  local  lesion. 

The  apathy  of  surgeons  to  medical  sug- 
gestions of  their  own  distinguished  mem- 
bers, past  and  present,  is  very  surprising, 
but  not  less  so  than  the  practical  disre- 
gard of  cancer  by  physicians.  One  finds 
the  strongest  expressions  in  regard  to  the 
constitutional  relations  of  cancer  by 
Lambe,  Abernethy,  Willard  Parker,  Sir 
Astley  Cooper,  Sir  James  Paget,  Esmarck, 
Sir  Arbuthnot  Lane,  and  others ;  and  finally 
Dr.  William  J.  Mayo,  in  his  recent  presi- 
dent's address  before  the  American  Surgi- 
cal Association,  asks,  ^'Is  it  not  possible, 
therefore,  that  there  is  something  in  the 
habits  of  civilized  man,  in  the  cooking  or 
other  preparation  of  his  food,  which  acts 
to  produce  the  precancerous  condition? '* 


EATIONAL  TREATMENT        23 

And  yet  there  has  been  relatively  little 
serious  attempt  to  investigate  this  line  of 
thought  or  to  test  the  principles  underly- 
ing the  metabolic  theory  of  cancer,  in  its 
relation  to  diet  and  mode  of  life,  as  in- 
fluenced by  so-called  civilization.  While 
the  microscope  and  laboratory  work  on 
animals  have  undoubtedly  advanced  the 
science  of  medicine  prodigiously,  they 
seem  to  have  reached  their  limit  in  regard 
to  cancer.  Their  negative  conclusions, 
however,  have  paved  the  way  for  the  med- 
ical man,  through  clinical  study  and  physi- 
ological chemistry,  to  reach  the  real  basic 
cause  of  the  disease  in  the  activities  of 
the  system  as  a  whole,  as  influenced  by 
diet  and  mode  of  life. 

This  plea  is  made,  therefore,  with  the 
hope  that  the  matter  may  be  thoroughly 
investigated  and  tested,  and  that  it  may 
result  in  a  more  rational  treatment  than 
the  present  one  of  attempting  only  to  re- 
move the  product  of  the  disease,  the  local 
tumor,  while  the  cause  of  the  formation 


24  MEDICAL  ASPECTS  OF  CANCER 

of  the  malgrowth  remains  still  active. 
Only  by  a  rational  treatment  of  the  cause 
can  we  hope  to  restrain  the  steady  in- 
crease of  cancer,  and  to  reduce  its  fright- 
ful mortality  of  90  per  cent,  of  those 
whom  it  has  once  attacked. 


CHAPTER  II 


Cancer  is  not  a  surgical  disease,  al- 
though of  late  years  cases  of  this  nature 
have  been  almost  always  relegated  to  the 
surgeon.  It  is  true  that  the  local  results 
of  the  cancerous  process  can  be  removed 
by  surgical  measures,  and  that  the  wound 
may  heal  primarily  and  that  in  some  pro- 
portion of  instances  the  tissues  may  re- 
main sound.  But  the  experience  of  all 
has  shown  that  the  mere  removal  of  the 
cancerous  tumor  and  adjoining  tissues  sur- 
gically does  not  insure  that  the  disease 
will  not  return  in  or  near  the  scar,  or 
elsewhere.  It  is  now  recognized  and  ac- 
knowledged that  somewhere  about  90  per 
cent,  of  those  once  affected  with  cancer 


♦  Read  at  the  Annual  Meeting  of  the  Medical  Soci- 
ety of  the  State  of  New  York,  at  Saratoga  Springs, 
May  17,  1916. 

25 


26  MEDICAL  ASPECTS  OF  CANCEE 

die  from  that  malady.  Surgery  as  a  cure 
for  cancer  has  been  tried  in  the  balance 
and  found  wanting,  since  under  its  super- 
vision and  treatment  the  death  rate  has 
increased  to  a  lamentable  degree  of  late 
years. 

According  to  the  United  States  Mor- 
tality Eeports,  the  deaths  from  cancer 
under  surgical  control,  have  increased 
steadily  and  alarmingly  since  1900,  when 
they  were  63  per  100,000  of  the  popula- 
tion, to  79.4  per  100,000  in  1914,  or  over 
25  per  cent.  During  the  same  period  the 
mortality  from  tuberculosis,  under  intelli- 
gent medical  supervision,  has  diminished 
from  201.9  to  146.8  per  100,000,  or  over 

27  per  cent.,  making  an  actual  difference 
of  over  50  per  cent,  in  their  relative  mor- 
tality since  1900.  At  this  rate  the  deaths 
from  cancer  will  outstrip  those  of  tu- 
berculosis in  fourteen  years  more.  Is  it 
not  time  for  us  to  seriously  consider 
whether  the  present  attitude  toward  can- 
cer is  correct  or  not! 


A  NON-SUEGICAL  DISEASE      27 

It  is  understood  that  the  present  in- 
quiry relates  to  cancer  as  a  disease  affect- 
ing many  different  organs ;  epithelioma  of 
the  skin  is  left  practically  out  of  consid- 
eration, as  it  is  a  relatively  mild  affair, 
when  properly  treated;  it  caused  a  com- 
paratively insignificant  proportion  of  the 
deaths  from  cancer,  2.7  per  100,000  pop- 
ulation, which  rate  has  increased  only  in 
a  trifling  degree  since  1900.  And  yet 
many  of  the  arguments  presented  in  the 
recent  surgical  propaganda  as  to  the  con- 
trol of  cancer  relate  to  the  early  surgical 
treatment  of  this  epithelial  disease  of  the 
skin! 

No  one  has  ever  seen  absolutely  the  first 
beginning  of  an  internal  cancer,  and  we 
have  no  knowledge  as  to  exactly  how  the 
process  starts;  although  microscopic  re- 
search on  cutaneous  cancer  has  revealed 
much  concerning  the  early  changes  occur- 
ring in  tissue  cells  in  this  disease. 

But  the  laboratory  has  not  told  us 
wherein  lies  the  malignity  of  the  true  dis- 


28  MEDICAL  ASPECTS  OF  CANCER 

ease  which  ultimately  destroys  so  many 
lives,  why  cells  which  were  once  normal 
take  such  a  morbid,  uncontrollable  and 
even  rampant  action  that  they  can  invade 
and  destroy  adjoining  and  distant  tissues. 
We  shall  see  later  that  the  hypothesis  of  a 
purely  local  origin  and  nature  of  cancer 
is  quite  untenable  in  the  light  of  modern 
investigation  and  thought. 

The  laboratory,  however,  both  in  a  neg- 
ative and  positive  manner,  has  done  much 
to  clear  up  our  field  of  vision,  and  to  open 
the  way  for  a  correct  understanding  of 
the  cancerous  process.  Time  does  not 
admit  of  even  a  brief  survey  of  the  enor- 
mous work  which  has  been  done  on  can- 
cer by  thousands  of  earnest  and  honest 
workers  in  laboratories,  at  a  vast  expen- 
diture of  time,  money,  and  animal  lives; 
but  a  concise  statement  of  the  status  of 
certain  questions  regarding  the  etiology  of 
the  disease  will  assist  us  in  properly  ap- 
preciating the  medical  aspects  of  the  sub- 
ject.    As  just  suggested,  the  points  thus 


A  NON-SUEGICAL  DISEASE      29 

far  acknowledged  by  those  who  have  most 
deeply  studied  cancer  are  both  negative 
and  positive,  and  may  be  mentioned  under 
these  heads: 

1.  Clinically  and  experimentally  cancer 
is  shown  to  be  not  contagious  or  infec- 
tious; although  under  just  the  right  con- 
ditions certain  malignant  new  growths  can 
be  inoculated  in  some  animals,  but  hu- 
man cancer  cannot  be  transplanted. 

2.  Although  micro-organisms  of  many 
kinds  have  often  been  found  and  claimed 
as  the  cause  of  cancer,  there  has  been  no 
concurrence  of  opinion  in  regard  to  them, 
and  it  is  now  pretty  conclusively  agreed 
that  cancer  is  not  caused  by  a  micro-or- 
ganism or  parasite. 

3.  Cancer  is  not  wholly  a  result  of  trau- 
matism, although  local  injury  may  have 
much  to  do  with  its  development  in  some 
particular  locality,  even  as  in  connection 
with  late  lesions  of  syphilis. 

4.  Cancer  is  not  hereditary  in  any  ap- 
preciable degree;  although  some  tendency 


30  MEDICAL  ASPECTS  OF  CANCER 

in  that  direction  has  been  demonstrated 
in  certain  strains  of  mice. 

5.  Occupation  has  not  any  very  great 
influence  on  the  occurrence  of  cancer;  al- 
though it  is  more  frequent  in  some  pur- 
suits than  in  others. 

6.  Cancer  is  not  altogether  a  disease  of 
older  years ;  although  its  occurrence  is  de- 
cidedly influenced  by  advancing  age. 

7.  It  does  not  especially  belong  to  or 
affect  any  particular  sex,  race,  or  class  of 
persons. 

8.  Cancer  is  not  confined  to  any  location 
or  section  of  the  earth,  but  has  been  ob- 
served in  all  countries  and  climates. 

But  while  laboratory  and  other  investi- 
gations have  not  demonstrated  any  sin- 
gle cause  of  cancer  and  have  yielded  only 
negative  results,  they  have,  by  elimina- 
tion, cleared  the  way  for  a  study  of  its 
cause  along  other  lines,  which  are  bright 
with  promise.  They  have  also  established 
certain  facts  which  confirm  the  views 
which  from  time  to  time  have  been  briefly 


A  NON-SURGICAL  DISEASE      31 

expressed  by  many  who  were  best  ac- 
quainted with  cancer;  namely,  that,  be- 
cause of  its  constant  recurrence,  and  from 
the  failure  of  surgery  to  check  its  rising 
mortality,  it  must  be  of  a  constitutional 
nature,  intimately  associated  with  dietary 
or  nutritional  elements,  as  I  have  else- 
where shown. 

The  positive  results  of  laboratory  inves- 
tigation are  more  encouraging: 

1.  We  know  now  that  the  local  mass, 
which  we  call  cancer,  represents  but  a  de- 
viation from  the  normal  life  and  action  of 
the  ordinary  cells  of  the  body.  These  once 
normal  cells  for  some  as  yet  unexplained 
reason,  take  on  an  abnormal  or  morbid 
action,  with  a  continued  tendency  to  ma- 
lignancy, which  invades  and  destroys  con- 
tiguous tissue,  and  is  associated  with  a 
progressive  anemia  which  destroys  life. 

2.  Microscopic  study  has  shown  that 
there  is  a  certain  change  in  the  polarity 
of  cells  about  to  be  cancer-genetic,  with 
an  altered  relation  of  the  centrosome  to 


32  MEDICAL  ASPECTS  OF  CANCER 

the  nucleus.  These  changes  are  again  at- 
tributed to  an  alteration  in  the  enzyme 
contained  in  the  cell,  which  further  de- 
pends on  the  nutrition  of  the  cell  as  in- 
fluenced by  a  faulty  metabolism  of  food 
elements. 

3.  The  exclusion  of  all  other  possible 
causes  leads  us  naturally  to  look  to  a 
disordered  metabolism  as  a  cause  of  the 
disturbed  action  of  the  hitherto  normal 
cells;  and  we  find  much  to  confirm  this 
view  both  in  laboratory  studies  on  the  bio- 
chemistry of  cancer,  and  also  in  clinical 
and  statistical  observations. 

4.  The  blood  in  advancing  cancer  has 
repeatedly  been  shown  to  exhibit  many 
manifest  changes,  which  indicate  vital  al- 
teration in  the  action  of  the  organs  which 
form  blood  and  so  control  the  nutrition 
of  the  body  and  its  cells. 

5.  Laboratoiy  and  clinical  evidence  dem- 
onstrate that  the  secretions  and  excretions 
of  the  body,  both  in  early  and  late  stages 
of  cancer,  exhibit  departures  from  normal 


A  NON-SURGICAL  DISEASE      33 

which  deserve  consideration.  Althou^ 
none  of  these  have  as  yet  been  established 
as  pathognomonic  of  cancer,  they  indicate 
metabolic  disturbances  which  influence  the 
nutrition  of  the  cellular  elements,  and  so 
these  secretory  and  excretory  disturbances 
are  of  importance  in  connection  with  its 
causation. 

6.  As  all  healthy  cells  of  the  body,  by 
their  catabolism  and  anabolism  contribute 
a  hormone  or  something  to  the  general 
circulation,  so  experimental  evidence 
shows  that  the  cells  of  a  cancer  mass  it- 
self, when  fully  developed,  secrete  a  hor- 
mone or  something  which  is  poisonous  to 
animals,  and  which  probably  hastens  the 
lethal  progress  of  the  disease. 

7.  Repeated  laboratory  experiences  have 
demonstrated,  in  a  most  remarkable  man- 
ner, the  absolute  controlling  effect  of  diet 
on  the  development  of  inoculated  cancer  in 
mice  and  rats,  so  that  the  process'  was 
inhibited  almost  entirely  with  certain  veg- 
etable feedings. 


34  MEDICAL  ASPECTS  OF  CANCER 

8.  We  thus  see  that  as  the  laboratory 
has  eliminated  the  local  nature  of  cancer, 
it  has  also,  in  a  measure,  established  the 
fact  that  there  are  medical  aspects  of  the 
disease  which  further  studies  will  show  to 
be  of  the  utmost  importance.  These  all 
tend  to  demonstrate  its  constitutional  ori- 
gin, that  is,  its  relation  to  deranged  met- 
abolism, which  is  now  recognized  as  the 
basis  of  so  many  diseases. 

But  clinical  and  statistical  studies  come 
in  with  overwhelming  force  to  confirm  the 
correctness  of  this  position. 

1.  We  have  already  seen  that  with  utter 
medical  neglect  cancer  mortality  has  stead- 
ily and  greatly  increased  in  the  United 
States,  of  late  years,  in  spite  of  the  pro- 
digious advances  in  surgery  during  the 
same  time.  We  have  seen  also  that  tu- 
berculosis, as  a  result  of  careful  medical 
attention,  has  decreased  in  mortality,  by 
an  even  greater  percentage.  The  same  is 
reported  by  reliable  observers  all  over  the 
civilized   world. 


A  NON-SURGICAL  DISEASE      35 

2.  Any  nmnber  of  observers,  in  many- 
lands,  have  recorded  tlie  almost  entire  ab- 
sence of  cancer  among  aborigines,  living- 
simple  lives,  largely  vegetarian;  they  have 
also  shown  the  definite  increase  in  the  dis- 
ease, and  in  its  mortality,  in  proportion 
to  their  adoption  of  the  customs  and  diet 
of  so-called  modern  civilization. 

3.  This  increase  of  cancer  seems  to  de- 
pend largely  upon  the  altered  conditions 
of  life,  particularly  along  the  lines  of  self- 
indulgence  in  eating  and  drinking,  and  in 
indolence.  neb  oj 

4.  Statistics  from  many  countries  show 
that  increase  in  the  consumption  of  meat, 
coffee,  and  alcoholic  beverages,  appears  to 
be  <;o-incident  with  a  very  great  and  pro- 
portionately greater  augmentation  of  the 
mortality  from  cancer. 

5.  Clinical  observation  has  time  and 
again  shown  the  effect  of  specific  nerve 
strain  and  shock  in  the  development  of 
cancer;  and  there  seems  to  be  little  ques- 
tion but  that  the  enormous  nerve  strain 


36  MEDICAL  ASPECTS  OF  CANCEE 

of  modern  life  is  an  element  of  impor- 
tance in  this  direction,  both  through  met- 
abolic disturbance,  and  by  direct  action  on 
living  cells. 

6.  At  present  no  clear  demonstration  is 
possible  of  the  direct  method  by  which 
errors  of  metabolism  effect  the  changes  in 
cells  to  which  we  give  the  name  malignant, 
any  more  than  we  know  how  other  alter- 
ations in  the  body  are  produced,  such  as 
arterial  degeneration,  bone  changes,  obes- 
ity, etc.,  which  are  recognized  as  due  to 
metabolic  derangement. 

7.  The  results  which  have  been  observed 
in  connection  with  the  starvation  of  can- 
cer, by  ligature  of  vessels,  illustrate  the 
relation  of  the  blood  supply  to  growing 
cancer. 

8.  Finally,  the  repeated  observation  and 
report  of  the  spontaneous  disappearance 
of  cancer,  by  careful  and  competent  med- 
ical men,  shows  that  conditions  of  the  sys- 
tem may  arise  which  are  antagonistic  to 
malignant  growth,  even  when  it  has  begun 


A  NON-SUEGICAL  DISEASE      37 

to  take  place ;  just  as  there  are  other  con- 
ditions of  the  system  which  favor  aber- 
rant  action  of  previously  normal  cells, 
resulting  in  cancer. 

The  medical  aspects  of  cancer  thus  ap- 
pear in  quite  a  different  light  from  that 
in  which  they  have  been  commonly  viewed. 
We  now  begin  to  see  some  of  the  reasons 
why  cancer  is  not  primarily  a  surgical 
disease,  and  some  of  the  lines  along  which 
observation  and  investigation  should  pro- 
ceed, namely,  biochemistry,  secretory  and 
excretory  derangements,  metabolic  distur- 
bances, diet,  etc.,  etc.  The  subject  is  too 
new  a  one  to  afford  a  great  amount  of 
corroborative  proof  at  present,  other  than 
the  long  personal  experience  of  the  writer 
and  others,  who  have  seen  tumors  disap- 
pear under  means  other  than  surgical,  ex- 
cluding also  a;-ray  and  radium.  More 
clinical  and  laboratory  studies  of  human 
beings  are  needed,  and  not  only  studies 
and  experiments  on  animals,  valuable  as 
these  have  been  in  the  advancement  of 


38  MEDICAL  ASPECTS  OF  CANCER 

medical  science  in  connection  with  other 
diseases. 

Time  does  not  here  permit  of  develop- 
ing the  lines  of  thought  and  practice 
along  the  dietary  and  medical  treatment 
of  cancer  which  can  be  successfully  car- 
ried out  in  early  cases,  and  which  are  of 
value  in  later  stages,  which  have  been  pre- 
sented elsewhere.  The  purpose  of  the 
present  paper  is  to  direct  attention  to  the 
hitherto  neglected  medical  aspects  of  can- 
cer, and  to  present  the  evidences  of  the  cor- 
rectness of  the  thesis  presented. 

It  is  fully  recognized  that  the  almost  uni- 
versal opinion  of  the  profession  and  the 
public  favors  only  a  surgical  aspect  and 
treatment  of  cancer,  and  it  is  difficult  to 
make  headway  against  such  odds.  It  is 
also  fully  recognized  that  there  is  a  certain 
danger  in  advocating  a  dietary  and  medi- 
cal control  of  cancer,  lest,  if  this  is  not 
properly  and  efficiently  understood  and 
carried  out,  failure  to  control  the  disease 
may  result  and  thereby  time  may  be  lost 


A  NON-SURGICAL  DISEASE      39 

in  which  a  surgical  operation  might  pos- 
sibly be  of  some  service.  But  after  many- 
years  of  observation  and  practice  along 
these  lines,  together  with  much  study  in 
later  years,  I  feel  constrained  to  urge  up- 
on the  profession  views  which  are  contrary 
to  those  which  are  accepted  by  so  many, 
who  perhaps  have  never  had  their  atten- 
tion seriously  turned  in  this  direction  be- 
fore. 

There  is  not  time  to  enter  into  details 
concerning  the  dietary  and  medical  treat- 
ment of  cancer,  which  have  been  presented 
elsewhere.  I  must  only  remind  you  that  to 
carry  out  this  line  of  treatment  success- 
fully requires  infinite  patience  and  the  ap- 
plication of  the  greatest  diligence  in  study- 
ing and  understanding  the  exact  condition 
of  the  patient,  and  meeting  every  possible 
departure  from  health,  and  rectifying 
every  derangement  of  metabolism. 

I  cannot  do  better  in  closing  than  to  re- 
mind you  that  the  medical  aspect  of  can- 
cer is  not  an  absolutely  new  proposition, 


40  MEDICAL  ASPECTS  OF  CANCER 

although  it  has  never  before  been  pre- 
sented in  a  definite  and  concrete  manner. 
Literature  is  full  of  allusions  to  the  sub- 
ject, without  any  attempt  to  fully  discuss 
it,  and  many  of  the  strongest  surgeons 
have  expressed  themselves  convinced  of  the 
constitutional,  and  largely  dietary,  origin 
of  the  local  lesion  which  we  call  cancer. 
This  view  finds  abundant  support  in  the 
writings  of  Lambe,  Abernethy,  Willard 
Parker,  Sir  Astley  Cooper,  Sir  James 
Paget,  Sir  Arbuthnot  Lane,  and  quite  re- 
cently has  been  advanced  by  Dr.  William 
J.  Mayo  and  many  others.  Is  it  not,  there- 
fore, high  time  that  serious  attention  be  di- 
rected away  from  the  purely  surgical  treat- 
ment of  a  symptom  or  result  of  a  great 
disease,  and  that  careful  inquiry  should  be 
made  into  the  underlying  causes  which  ul- 
timately result  in  such  a  great  relative 
mortality,  approaching  90  per  cent,  of  all 
those  affected,  exceeding  that  of  any  other 
one  disease! 


CHAPTER   in 

CANCER     DEATH     RATE     IN     NEW     "YORK     CITY 
DURING  1917 

In  1914  the  New  York  Board  of  Health 
in  its  Monthly  Bulletin  for  April  presented 
a  long  article  from  the  American  Society 
for  the  Control  of  Cancer  on  *' Cancer  as  a 
Public  Health  Problem.''  From  this  some 
data  may  be  quoted. 

Based  on  the  statistics  from  the  United 
States  Registration  area  up  to  1912,  it 
showed  very  clearly  and  indisputably  the 
steady  and  great  increase  in  the  mortality 
from  cancer  from  the  year  1900,  when  it 
was  63  per  100,000  to  77  per  100,000  in 
1912,  or  22.22  per  cent.  In  New  York  State 
the  increase  had  been  from  66  in  1900  to 
86.5  per  100,000  in  1913,  or  over  30  per 
cent.  In  New  York  City  it  had  risen  from 
41 


42  MEDICAL  ASPECTS  OF  CANCER 

63.3  in  1898  to  81.7  per  100,000  in  1913,  or 
over  29  per  cent.  Throughout  the  world 
the  cancer  death  rate  from  1900  to  1909 
had  advanced,  on  an  average  of  all  coun- 
tries reporting,  23.3  per  cent.  Cancer 
was  rightly  spoken  of  as  '*a  menace  to  so- 
ciety. ' ' 

The  question  of  the  apparent  or  real  in- 
crease in  mortality  was  discussed,  and  it 
was  remarked  that  *'it  seems  unlikely  that 
accuracy  of  diagnosis  has  advanced  at  such 
an  even  rate  as  to  result  in  almost  exactly 
the  same  addition  to  the  recorded  cancer 
death  rate  each  year. ' ' 

Since  1914,  when  there  was  started  the 
active  propaganda  for  the  more  radical 
surgical  treatment  of  cancer,  the  increase 
in  the  death  rate  has  been  much  greater 
than  before  that  time.  Thus  in  the  United 
States  the  mortality  figure  has  steadily 
risen,  so  that  in  1915  it  was  81.1  per  100,- 
000,  or  a  total  rise  of  28.7  per  cent.,  since 
1900.  In  1916  it  was  81.8  per  100,000,  or 
29.84   per   cent,   increase   since   1900. 


1917  MORTALITY  IN  NEW  YORK  43 

It  is  a  little  interesting  to  note  that  dur- 
ing the  five  years  immediately  preceding 
1915,  at  which  date  surgeiy  became  more 
active,  the  mortality  rose  only  from  76.2  to 
79.4,  a  total  of  3.2  deaths  per  100,000  popu- 
lation, or  much  less  than  one  per  year; 
while  in  1915,  after  the  vigorous  educa- 
tional and  surgical  propaganda,  the  death 
rate  rose  from  79.4  in  1914  to  81.1  per 
100,000,  or  1.7  more  deaths  per  100,000 
population  in  a  single  year;  this  is  an  in- 
crease of  2.13  per  cent.,  more  than  double 
that  in  the  preceding  years.  Could  this  be 
ascribed  to  more  accurate  diagnosis? 

A  confirmation  of  the  reality  of  the  in- 
crease in  deaths  from  cancer  happens  to 
come  in  the  Bulletin  of  the  North  Dakota 
State  Board  of  Health  for  October,  1917. 
In  it  we  find  a  quarterly  mortality  sum- 
mary of  all  the  deaths  during  July,  August 
and  September,  1917,  with  a  column  com- 
paring these  with  the  data  of  1916.  We 
find  that  while  the  general  death  rate, 
partly  or  wholly  due  to  increase  of  popu- 


44  MEDICAL  ASPECTS  OF  CANCER 

lation,  had  risen  22  per  cent.,  the  increase 
in  the  cancer  death  rate  had  increased  30 
per  cent. — from  more  accurate  diagnosis? 

Turning  now  to  the  mortality  from  can- 
cer, in  New  York  City,  in  1917,  as  shown 
in  the  Weekly  Bulletin  of  the  New  York 
Board  of  Health,  we  find  that  there  were 
4,859  deaths  recorded  from  cancer,  ma- 
lignant tumor,  2,143  males  and  2,716  fe- 
males. This  total  number  divided  by  365 
gives  13.33  persons  dying  daily  from  this 
cause.  During  1916  there  were  4,635 
deaths  from  cancer,  or  12.68  persons  per 
day. 

During  1917  there  was  a  total  of  78,467 
deaths  from  all  causes  in  Greater  New 
York  against  77,948  in  1916,  an  increase  of 
519,  or  less  than  one  per  cent. ;  whereas  the 
increase  in  cancer  deaths  was  224  or  al- 
most five  per  cent.  Surely  such  figures, 
which  cannot  lie,  and  which  show  an  in- 
crease of  cancer  mortality  nearly  five  times 
that  from  general  causes,  cannot  be  ex- 
plained away  by  greater  accuracy  of  diag- 


1917  MORTALITY  IN  NEW  YORK  45 

nosis  or  more  perfect  recording  of  death 
certificates. 

In  all  this  study  of  mortality  statistics 
it  is  well  to  remember  that  these  figures 
do  not  necessarily  represent  truly  the  real 
increase  of  cancer  as  a  disease,  which  is 
probably  even  much  greater  than  the  fig- 
ures show.  For  undoubtedly  many  cancer 
patients  die  of  intercurrent  diseases,  under 
which  the  death  is  recorded,  and  in  many 
instances  the  diagnosis  of  cancer  is  with- 
held from  the  death  certificate  for  per- 
sonal or  family  reasons. 

The  alarming  increase  in  the  death  rate 
from  cancer  under  surgical  care  may  well 
be  compared  with  the  notable  and  steady 
decrease  in  the  deaths  from  tuberculosis 
under  rational  and  careful  medical  super- 
vision and  treatment.  In  1900  the  death 
rate  from  tuberculosis,  in  the  United  States 
Registration  area,  was  201.9  persons  in 
each  100,000  population,  and  by  1916  it  had 
fallen  to  141.6  or  a  decrease  of  60.3  per- 
sons in  100,000,  or  almost  30  per  cent.; 


46  MEDICAL  ASPECTS  OF  CANCER 

whereas  during  the  same  period  the  death 
rate  of  cancer  had  risen  29.84  per  cent. !  In 
1900  the  two  diseases  were  138.9  points 
apart  in  mortality,  and  in  1916  only  59.8 
apart ;  at  this  rate  of  increase  and  decrease 
cancer  will  soon  claim  more  victims  in 
each  100,000  population  than  tuberculosis. 
In  the  light  of  what  has  preceded  is  it 
not  possible  that  there  is  something  wrong 
in  our  conception  of  cancer  and  its  treat- 
ment, as  I  have  repeatedly  endeavored  to 
show  f  If  any  other  disease  presented  such 
a  steady  and  alarming  rise  in  its  death  rate 
would  we  not  stop  and  consider  if  our 
treatment  were  the  best  possible!  If,  with 
the  introduction  of  antitoxin,  the  mortality 
from  diphtheria  had  steadily  risen  until  it 
was  90  per  cent,  of  all  cases,  which  is  the 
acknowledged  ultimate  death  rate  of  can- 
cer, would  we  persist  in  employing  it! 
And  yet  the  profession  and  laity  go  blindly 
on  with  the  idea  that  surgery  offers  the 
best  and  only  hope  of  reaching  cancer,  by 
removing  a  local  lesion  which  is  only  the 


1917  MORTALITY  IN  NEW  YORK  47 

product  of  a  previous  constitutional  de- 
parture from  health.  As  well  might  one 
excise  a  syphilitic  gumma,  or  a  tubercu- 
losis lesion,  or  amputate  a  gouty  toe,  with- 
out other  treatment,  and  hope  that  there 
would  be  no  further  trouble;  for  all  ex- 
perience shows  that  cancer  is  exceedingly 
prone  to  manifest  itself  anew,  either  in 
the  same  location  or  elsewhere.  ^Utt  t>«j 
It  is  a  curious  comment  on  human  cre- 
dulity that  with  this  steady  rise  in  its  mor- 
tality so  many  should  have  accepted  the 
dictum  that  cancer  was  only  a  surgical  dis- 
ease, and  reached  only  by  surgical  meas- 
ures, when  all  along  the  past  one  hundred 
years  single  voices  of  surgeons  and  medi- 
cal men  have  now  and  again  spoken  so 
strongly  in  favor  of  its  constitutional  ori- 
gin, as  I  have  shown  in  my  first  volume. 
The  lure  of  surgery  is  strong,  and  sur- 
geons have  made  great  claims,  while  medi- 
cal men  have  not  yet  reported  any  single 
specific  for  the  disease,  for  the  single  rea- 
son that  no  specific  will  ever  be  found. 


48  MEDICAL  ASPECTS  OF  CANCER 

It  is  not  the  purpose  of  the  present  writ- 
ing to  enter  upon  the  proof  of  the  constitu- 
tional nature  of  cancer  and  its  successful 
treatment  by  other  than  surgical  measures, 
which  have  been  abundantly  considered  in 
the  books  referred  to.  It  can,  however,  be 
truthfully  claimed  that  under  proper  and 
prolonged  medical  treatment  more  can 
be  effected  than  with  the  knife.  Not  only 
is  the  death  rate  smaller,  but  the  ultimate 
suffering  is  less.  Moreover,  with  the  fear 
of  an  operation  removed,  together  with  the 
known  uncertainty  as  to  the  ultimate  re- 
sult, patients  would  be  more  inclined  to 
seek  aid  in  the  earlier  stages  of  the  dis- 
ease, when  the  prospects  of  overcoming  it 
are  better. 


CHAPTER   IV 

CANCEB  DEATH  RATE  IN    NEW   YORK   CITY 
DURING    1918 

Mortality  statistics  are  an  interesting 
and  instructive  study  in  their  relation  to 
therapeusis,  as  all  recognize.  For  if  a  new 
remedy  or  course  of  treatment  for  any 
disease  were  introduced  and  year  by  year 
the  death  rate  from  that  disease  was 
shown  to  rise,  eager  search  would  be 
made  for  other  remedies  or  measures  to 
check  the  same.  Years  ago  tuberculosis 
was  called  the  great  white  plague,  increas- 
ing in  mortality  so  greatly  that  fear  was 
excited  that  it  would  sweep  off  nations; 
but  we  know  now  that  with  well  directed 
medical  care  its  death  rate  has  diminished 
thirty  per  cent,  since  1900  in  the  United 
States.  Syphilis,  the  great  black  plague, 
swept  through  Europe  and  elsewhere  in 
49 


50  MEDICAJ.  ASPECTS  OF  CANCER 

the  16tli  and  17th  centuries,  whole  towns 
and  communities  being  infected,  often 
quite  innocently,  until  the  proper  use  of 
mercur^^  with  the  recent  introduction  of 
Salvarsan  has  largely  rid  the  world  of  the 
fear  of  this  foul  disease.  Leprosy  was 
once  alarming,  but  under  wise  manage- 
ment and  the  knowledge  of  its  non-con- 
tagiousness it  has  lost  much  of  its  terrors. 
Yellow  fever  and  cholera  no  longer 
threaten  regions  where  scientific  medical 
activity  controls.  But  our  recent  experi- 
ence with  poliomyelitis  and  the  Spanish 
grip  show  that  there  is  yet  much  for  the 
medical  profession  to  investigate  and  con- 
quer. 

Cancer,  the  great  red  plague,  still  holds 
its  own  as  a  menace  to  civilization,  for 
the  United  States  Mortality  Tables  show 
that  since  1900  its  death  rate  has  risen 
nearly  30  per  cent.,  almost  as  much  as  that 
of  tuberculosis  has  fallen;  and  it  is  com- 
monly asserted  that  90  per  cent,  of  those 
once  affected  die  from  the  disease,  under 


1918  MORTALITY  IN  NEAV  YORK  51 

the  prevailing  treatment.  It  is  certainly 
time  to  consider  well  what  should  be  done 
to  check  this  fearful  mortality. 

But  the  death  rate  from  Cancer  in  New 
York  City,  during  the  past  year  1918, 
seems  to  show  that  wiser  counsels  are  be- 
ginning to  prevail,  as  appears  from  the 
weekly  reports  of  the  New  York  Depart- 
ment of  Health. 

During  1916,  as  previously  reported, 
there  were  4635  deaths  from  cancer, 
malignant  tumor  (an  average  of  12.68  per- 
sons daily)  while  during  1917  there  were 
4859  deaths,  2143  males  and  2716  females 
(an  average  of  13.31  persons  daily)  an 
excess  of  224,  that  is  almost  five  per  cent, 
increase:  whereas  the  increase  in  deaths 
from  all  causes  was  only  519,  or  less  than 
one  per  cent. 

During  1918  there  were  4895  deaths 
from  cancer,  2150  males  and  2745  females, 
(an  average  of  13.39  persons  daily),  or 
an  increase  of  only  36  deaths  over  last 
year;  that  is,  less  than  one  per  cent.,  as 


52  MEDICAL  ASPECTS  OF  CANCER 

against  a  five  per  cent,  increase  of  224  for 
last  year,  1917,  over  the  preceding  year, 
1916. 

If  figures  teach  anything  they  seem  to 
show  that  in  New  York  City  the  profes- 
sion is  beginning  to  learn  that  the  hereto- 
fore rash  attempt  to  cure  cancer  with  the 
knife  is  giving  way  to  wiser  procedures. 


CHAPTER  V 


CANCEB  FKOM  A  MEDICAL  STANDPOINT.* 


In  his  excellent  address  Dr.  Bloodgood 
has  presented  most  ably  the  surgical  as- 
pects of  the  control  of  cancer,  and  I  can 
concur  with  pleasure  in  every  word  he  has 
said.  I  only  regret  that  time  did  not  al- 
low him  to  show  all  of  his  pictures,  that 
you  might  better  understand  the  different 
phases  of  cancer,  and  better  appreciate 
the  disease  with  which  we  have  to  deal, 
which  kills  75,000  persons  in  the  United 
States  yearly,  with  an  acknowledged  ulti- 
mate mortality  of  about  90  per  cent,  from 
it,  of  all  who  are  once  attacked.  He  has 
warned  you  of  the  danger  of  delay  in  at- 
tending to  the  disease,  and  urged  early 


*  Address  before  the  Medical  Society  of  the  State 
of  New  York,  Eighth  District  Branch,  September  22, 
1915. 

53 


54  MEDICAL  ASPECTS  OF  CANCER 

and  complete  surgical  removal,  which  is 
certainly  most  wise  when  such  measures 
are  decided  on. 

But,  gentlemen,  did  you  notice  the 
figures  which  Dr.  Bloodgood  gave  in  re- 
gard to  the  end  results  of  the  surgical 
control  of  cancer!  He  stated  that  one- 
half,  or  50  per  cent,  of  all  cases  of  cancer 
are  inoperable  when  they  are  seen  by  the 
surgeons!  Did  you  notice  that  of  the 
other,  operable  one-half,  not  over  25  per 
cent,  ultimately  recover  and  remained 
permanently  well,  under  the  best  surgery  1 
Adding  these  figures  together  we  have 
871/2  per  cent,  of  all  cases  of  cancer,  in 
different  locations  which  are  not  reached 
by  surgery,  but  which  succumb  to  the  dis- 
ease! Did  you  notice  also  that  he  said 
that  the  percentage  of  cures  mentioned 
related  to  the  *^best  surgery,''  from  which 
one  must  infer  that  the  mass  of  cases 
under  ordinary  surgery  would  show  a 
still  smaller  ratio  of  cures:  for  relatively 
few   of   the    200,000   continually    existing 


MEDICAL  CONSIDERATIONS     55 

cancer  patients  can  afford  to  go  to  such 
brilliant  operators  as  the  Mayos  or  Dr. 
Bloodgood. 

What  then  of  the  other  871/2  per  cent, 
of  cases  for  which  surgery  offers  no  hope? 
Are  they  to  be  left  to  struggle  unaided 
against  the  dire  disease,  until  relieved 
by  death?  I  have  frequently  protested 
against  the  course  which  is  usually  fol- 
lowed in  regard  to  cancer,  both  before  and 
after  operation.  With  a  rather  extended 
experience  during  the  last  forty  years  and 
more,  I  have  rarely  if  ever  found  a  pa- 
tient with  cancer  who  has  received  ade- 
quate and  continuous  care  before  opera- 
tion, with  a  view  of  discovering  and  recti- 
fying the  cause  of  the  morbid  growth. 
Too  often  when  a  cancer  is  suspected  or 
discovered  it  is  regarded  as  a  foregone 
conclusion  that  the  malady  is  hopeless,  ex- 
cept as  the  results  of  the  disease,  that 
is,  the  new  growth,  may  be  removed  by 
the  knife,  x-rajj  radium,  caustics,  etc., 
only   too   often   to    recur.     And   after   a 


56  MEDICAL  ASPECTS  OF  CANCER 

surgical  operation,  as  far  as  my  observa- 
tion goes,  the  patients  are  invariably  left 
entirely  to  their  own  resources,  with  the 
hope,  alas,  too  often  futile,  that  the  tumor 
will  not  regrow,  but  with  no  attempt  to 
so  guide  the  life  that  there  shall  not  be 
the  same  tendency  to  a  recurrent  malig- 
nant new  formation.  I  would  like  to  ask 
if  any  one  present  has  had  a  different  ex- 
perience, if  so  to  kindly  raise  the  hand. 
I  wait  for  an  answer:  but  as  none  comes 
I  take  it  for  granted  that  you  all,  as  medi- 
cal men,  follow  the  general  custom  of 
turning  over  all  cancer  cases  to  the  sur- 
geon or  to  the  undertaker. 

And  yet,  gentlemen,  after  many  years 
of  study,  observation,  and  experience,  I 
believe  that  the  present,  common  attitude 
toward  cancer,  is  all  wrong,  and  that  while 
surgery  may  always  have  its  function  to 
perform,  in  removing  certain  obnoxious 
products  of  the  disease,  more  or  less  ef- 
ficiently, curing  some  patients  and  pro- 
longing the  life  of  others,  it  can  never 


MEDICAL  CONSIDERATIONS     57 

hope  to  lessen  greatly  the  morbidity  of 
cancer.  I  believe,  however,  that  its  mor- 
bidity and  mortality  can  be  materially  di- 
minished if  intelligent,  serious,  and  pro- 
longed attention  is  given  to  it  from  a 
medical  standpoint,  along  metabolic  lines, 
which  line  of  thought  finds  abundant  sup- 
port both  from  laboratory  work  and  from 
statistical  teachings  and  clinical  experi- 
ence, all  along  the  past  years. 

Time  will  not  allow  me  to  elaborate  at 
all,  as  I  would  like  to,  the  proof  of  my  as- 
sertion, and  I  do  not  know  how  many  of 
you  will  believe  what  I  say.  Dr.  Park 
Lewis  yesterday  quoted  an  unknown 
writer  who  said  that  it  is  necessary  to  re- 
peat a  proposition  five  times  to  have  it 
effective,  for  the  reason  that  the  first  time 
one  does  not  hear,  the  second  he  gives  no 
attention,  the  third  he  does  not  under- 
stand, and  the  fourth  he  does  not  believe, 
so  the  fifth  repetition  is  necessary.  Un- 
fortunately I  can  not  repeat  everything 
five  times,  so  please  believe  at  once,  for 


58  MEDICAL  ASPECTS  OF  CANCER 

what  I  am  to  say  is  vital  and  serious  to 
the  hosts  of  cancer  sufferers,  present  or 
future;  and  I  stake  my  reputation  on  the 
truth  of  it,  which  I  believe  will  be  widely 
accepted  before  long.  As  a  basis  for 
my  thesis  I  beg  you  to  look  carefully 
at  the  wall  chart  before  you,  which  is  an 
exact  copy  of  one  in  the  volume  of  United 
States  Mortality  Statistics  for  1913.* 

This  represents  the  recorded  deaths, 
from  several  diseases,  in  the  registration 
areas  from  1900  to  1913.  The  upper  red 
line  shows  that  the  mortality  of  all  forms 
of  tuberculosis  has  steadily  fallen  over 
25  per  cent,  during  that  period.  We  fur- 
ther see  that  organic  heart  disease  gives 
a  constant  rise  in  death  rate,  of  from  15 
to  20  per  cent.,  nephritis  nearly  15  per 
cent.,  and  apoplexy  over  10  per  cent., 
while  the  deaths  from  cancer  have  coin- 
cidently  increased  from  63  to  78.9  per 
100,000,  or  over  25  per  cent. ;  in  New  York 
City  there  are  twelve  deaths  from  cancer 

*  This  chart  is  now  brought  ap  to  1917. 


From  United  States  Mortdlity 

Stdti 

Sties  1917 

ZIO 
i.  200 
'^  190 
^  180 
0-170 
C^  160 
g   150 
§   140 
^130 

S_izo 

o    110 
-^   100 
g    90 
^   80 
«    70 
^    60 
50 

I9Q0 

1901 

1902 

1902 

1904 

1905 

1906 

1907 

m 

1909 

1910 

1911 

1912 

1913 

1914 1915 

1916 

1917 

210 
200 
190 
180 
170 
160 
150 
140 
130 
120 
110 
100 
90 
80 
70 
60 
50 

■%.= 

o 

"^ 

, 

/ 

/^ 

^. 

V. 

^ 

\ 

> 

A^, 

N 

s. 

\ 

/ 

^\ 

^ 

V 

^_ 

^ 

■"— 

J 

\ 

/ 

"^ 

-^-\ 

N 

r-^ 

^ 

-^^ 

^ 

-J. 

\^ 

^ 

-^ 

v^ 

X_ 

^ 

-— . 

^ 

J 

,,!« 

v^^^ 

y 

V- 

V- 

— 

"-> 

^ 

^ 

J^ 

\y 

y'O 

^ 

-^ 

/\ 

/- 

-^ 

-- 

.»** 

^ 

y 

KC^ 

^ 

— - 

~~^ 

_!iJ^ 

i^ 

jipf 

ftrC 

yy 

^ 

;;^ 

■^ 

^ 

■^ 

-^ 

^ 

^^ 

-^ 

.»« 

'^ 

"CAI 

CfP 

^ 

"" 

r^ 

MEDICAL  CONSIDERATIONS     59 

everj^  day,  according  to  the  statistics  of 
the  Board  of  Health. 

It  is  worth  while  to  consider  these 
figures  seriously  for  a  moment,  and  the 
lessons  they  teach  us.  The  mortality 
from  tuberculosis  has  declined  over  25  per 
cent,  in  these  thirteen  years ;  how  has  this 
been  accomplished!  By  the  surgeons  cut- 
ting out  its  lesions!  Not  at  all,  but  by  a 
steady,  persistent,  medical  attention  to 
the  disease  in  all  its  aspects,  and  by  the 
application  of  correct  principles  of  liv- 
ing, largely  dietetic ;  for,  when  we  give  the 
patients  fresh  air  and  sunlight  we  promote 
a  proper  metabolism,  or  nutrition,  which 
enables  the  system  to  resist  the  still  pres- 
ent bacillus  of  tuberculosis. 

We  have  further  seen  from  the  chart 
that  organic  heart  disease,  nephritis,  and 
apoplexy  present  a  constantly  rising  mor- 
tality, and  no  one  questions  that  they  are 
due  to  errors  in  living,  incident  to  mod- 
em civilization,  especially  along  the  lines 
of  food  and  drink,  with  want  of  proper 


60  MEDICAL  ASPECTS  OF  CANCER 

exercise  to  promote  perfect  metabolism 
and  elimination. 

Now  cancer  closely  follows  the  same 
lines  of  increasing  mortality,  only  it  ex- 
ceeds them  all,  it  having  risen  over  25 
per  cent,  in  the  same  thirteen  years;  the 
death  rate  for  1913  was  78.9  per  100,000, 
the  highest  ever  attained,  in  spite  of  ever 
increasing  activity  in  the  study  of  can- 
cer, and  transcendent  zeal,  intelligence, 
and  skill  in  the  surgeons,  who  are  trying 
to  control  it. . 

I  submit  to  you,  gentlemen,  if  the  argu- 
ment does  not  seem  overwhelming  that 
cancer  is  no  longer  to  be  regarded  as  a 
purely  local  disease,  but  that,  as  its  death 
rate  rises  coincidently  with  that  of  the 
other  diseases  mentioned,  it  must  have  a 
more  or  less  similar  cause;  and  with  the 
utter  failure  of  surgery  to  control  its  in- 
crease, we  must  look  in  some  other  direc- 
tion for  means  to  check  its  morbidity  and 
mortality? 

Time  fails  me  to  expound  to  you  at  all 


MEDICAL  CONSIDEEATIONS    61 

fnlly  the  line  of  argument  supporting  all 
this,  which  is  based  on  published  labora- 
tory studies  in  the  physiological  chemis- 
try and  metabolism  of  cancer,  as  quoted  in 
my  little  book  on  *' Cancer,  Its  Cause  and 
Treatment'';  nor  can  I  give  more  than  a 
slight  reference  to  the  many  expressions 
found  in  literature,  by  men  well  acquainted 
with  cancer,  who  have  clinically  been  im- 
pressed with  the  constitutional  nature  of 
the  trouble,  of  which  the  local  lesion, 
or  cancer,  is  but  a  result.  But  that  you 
may  know  that  I  am  not  alone  in  urging 
a  medical  consideration  of  cancer,  I  must 
very  briefly  refer  to  a  few  prominent 
names  of  those  whose  opinion  should  bear 
weight.  Indeed,  the  more  I  study  litera- 
ture, new  and  old,  the  more  I  wonder 
that  the  valuable  suggestions  found  there 
have  not  already  directed  serious  atten- 
tion to  and  investigation  of  this  aspect 
of  the  disease,  in  place  of  the  immense 
amount  of  labor  and  expense  which  has 
been  given  to  laboratory  studies  with  the 


(32  MEDICAL  ASPECTS  OF  CANCER 

microscope  and  test  tube,  and  experiments 
on  rats  and  mice! 

Nearly  100  years  ago  the  great  Aber- 
nethy,  in  his  ''Surgical  Observations  on 
Tumors'*  wrote:  ''There  can  be  no  sub- 
ject which  I  think  more  likely  to  interest 
the  mind  of  the  surgeon,  than  that  of  an 
endeavor  to  amend  and  alter  the  state  of 
a  cancerous  constitution.  The  best  timed 
and  best  conducted  operation  brings 
with  it  nothing  but  disgrace,  if  the  dis- 
eased propensities  of  the  constitution 
are  active  and  powerful.  It  is  after  an 
operation  that,  in  my  opinion,  we  are 
most  particularly  incited  to  regulate  the 
constitution,  lest  the  disease  should  be  re- 
vived or  renewed  by  its  disturbance." 
Following  down  in  time  I  have  quoted  from 
Walshe,  Willard  Parker,  Sir  Astley  Coop- 
er, Sir  James  Paget,  Sir  Arbuthnot  Lane, 
and  others,  all  of  whom,  often  in  very 
strong  language,  declare  emphatically 
their  belief  in  the  constitutional  nature  of 


MEDICAL  CONSIDERATIONS     63 

cancer,  many  of  them  attributing  it  to 
dietary  errors. 

The  most  recent  supporters  of  this  view 
are  Dr.  Wm.  J.  Mayo,  who  in  his  presi- 
dential address  before  the  American  Sur- 
gical Association  alluded  to  the  matter  a 
number  of  times,  in  no  uncertain  language, 
and  Dr.  James  Ewing  of  Cornell  Univer- 
sity, who  in  discussing  the  subject  said  to 
me,  '^Bulkley,  I  believe  you  are  right,  and 
our  laboratory  is  now  devoting  itself  to 
metabolic  studies  in  cancer." 

I  wish  that  I  could  give  you  briefly  my 
experience  in  following  this  line  of 
thought  and  treatment  in  cancer  cases  in 
private  practice,  during  more  than  thirty 
years,  and  in  the  New  York  Skin  and 
Cancer  Hospital  more  recently,  upon  the 
special  request  of  the  Board  of  Governors, 
but  must  refer  you  to  what  I  have  written 
on  the  subject.  I  may  say  in  advance 
that  I  am  not  here  to  offer  any  special 
new  form  of  treatment  or  any  novel  or 
certain  cure  for  cancer.     Sadly  the  rising 


64  MEDICAL  ASPECTS  OF  CANCER 

mortality  path  of  cancer  is  strewn  with  the 
wrecked  hopes  of  multitudes  of  sufferers 
who  have  tried  in  vain  the  innumerable 
** Cancer  Cures'^  brought  forth  and  often 
vaunted  loudly,  both  by  those  who  were 
within  and  those  outside  of  the  regular 
medical  profession.  Personally  I  do  not 
believe  that  any  one  remedy,  whether  it  be 
a  serum  or  a  pharmaceutical  combination, 
will  ever  be  found  which  can  be  spoken  of 
as  a  **cure  for  cancer, '^  although  some  of 
them  have,  for  a  while,  seemed  to  be  of 
service.  The  reason  for  this  belief  is  found 
in  the  true  nature  of  the  disease  itself. 

The  basic  cause  of  the  nutritive  dis- 
turbance which  eventuates  in  the  new 
growth  which  we  call  cancer,  being  a  dis- 
ordered metabolism,  due  to  many  causes, 
it  seems  entirely  irrational  to  suppose  that 
any  brief  course  of  medication  by  injec- 
tion or  otherwise,  can  alter  the  deranged 
metabolism,  or  affect  the  organs  concerned 
in  nutrition,  in  such  a  manner  that  they 
will  permanently  operate  correctly  if  the 


MEDICAL  CONSIDERATIONS     65 

dietetic  or  other  errors  which  induced  the 
malignant  new  growth  are  allowed  to  per- 
sist and  perpetuate  the  disorder. 

The  real  problem  in  regard  to  the  proph- 
ylaxis and  cure  of  cancer,  therefore,  re- 
lates to  such  a  modification  of  the  condi- 
tions of  life  as  will  induce  a  perfect  blood 
stream  which  carries  on  a  perfect  anab- 
olism  and  catabolism,  resulting  in  the  for- 
mation of  normal  body  cells,  in  place  of  the 
heterologous  cells  of  cancer. 

Time  does  not  permit  of  the  elabora- 
tion of  the  subject  as  one  could  wish,  but 
to  make  my  position  clear  I  must  very 
briefly  touch  upon  some  of  the  principal 
points  involved,  which  I  have  presented 
in  my  little  book.  I  must  first  state  that 
I  quite  agree  that  chronic  irritation  has 
much  to  do  with  the  localization  of  the 
morbid  growth,  even  as  local  injury  will 
commonly  induce  the  local  manifestations 
of  gout,  rheumatism,  and  late  syphilis.  I 
also  accept  the  view  that  probably  the 
malignant  growths   of  cancer  take  their 


66  MEDICAL  ASPECTS  OF  CANCER 

origin  in  *' embryonic  rests,"  or  wrongly 
placed  epithelial  elements.  But  repeated 
irritation  occurs  continually  without  caus- 
ing cancer,  and  we  are  told  that  *' embry- 
onic rests"  exist  in  every  one,  even  in 
great  numbers,  while  relatively  few  indi- 
viduals are  affected  with  cancer. 

It  would  appear,  therefore,  that  some- 
thing more  is  necessary,  and  that  is  found 
in  the  soil  in  which  the  '^embryonic  rest" 
germinates,  or  rather  in  a  vitiated  blood 
stream,  perverted  by  a  deranged  metabo- 
lism, which  is  again  dependent  upon  the 
erroneous  life  induced  by  modern  civili- 
zation. You  all  know,  undoubtedly,  that 
it  has  been  pretty  clearly  shown  that  can- 
cer is  a  disease  of  civilization,  and  that 
the  morbidity  and  mortality  of  cancer 
have  increased  with  its  advance,  and  with 
its  attendant  evils  of  over-indulgence  in 
eating  and  drinking,  with  indolence,  nerve 
strain,  etc.;  these  all  help  to  pervert  met- 
abolism, and  are  more  or  less  accountable 
for  disease  of  the  heart,  kidneys,  and  brain. 


MEDICAL  CONSIDERATIONS     67 

whose  steadily  rising  mortality  does  not, 
however,  keep  pace  vdth  that  of  cancer. 

You  know  also  that  the  errors  of  diet 
lie  largely  along  excess  of  animal  pro- 
tein, coffee,  and  alcohol,  and  that  cancer 
mortality  is  the  highest  where  the  per 
capita  consumption  of  these  is  greatest. 
You  know  likewise  that  cancer  is  exceed- 
ingly rare  among  herbivorous  animals  and 
aborigines  who  follow  a  diet  largely  com- 
posed of  vegetables,  fruits,  and  cereals; 
moreover  laboratory  studies  have  demon- 
strated that  feeding  has  the  greatest  in- 
fluence on  the  effect  produced  by  the  ar- 
tificial inoculation  of  cancer  in  rats  and 
mice,  and  that  an  absolute  rice  diet  al- 
most inhibits  its  development.  The  teach- 
ing of  all  this  is  that  in  the  human  being 
an  absolute  vegetarian  diet  plays  a  very 
important  part  both  in  the  prophylaxis 
against  cancer  and  in  its  treatment,  with 
or  without  surgical  operation. 

But  there  are  other  elements  connected 
with  the  production  and  control  of  cancer 


68  MEDICAL  ASPECTS  OF  CANCER 

which  must  be  very  briefly  alluded  to, 
that  you  may  fully  appreciate  cancer  from 
a  medical  standpoint. 

Proper  and  perfect  elimination  of  the 
waste  products  of  the  body  is  the  basis  of 
all  good  health,  and  imperfect  or  deficient 
elimination  is  the  source  of  innumerable 
ills  to  which  different  names  are  given; 
why  the  results  are  different  in  different 
individuals  one  does  not  know,  and  per- 
haps never  will  know,  but  careful  clinical 
observation,  both  in  recent  and  recurrent 
cancer,  shows  certain  faulty  conditions 
of  elimination  which  are  believed  to  be 
related  to  the  etiological  factors  of  the 
disease.  These  are  exhibited  in  the  excre- 
tion from  the  kidneys  and  the  intestines. 
This  is  a  very  large  subject,  and  time  does 
not  permit  of  more  than  the  bare  mention 
of  the  fact  that  cancer  patients,  even  in 
the  very  early  stages  are  almost  uniform- 
ly constipated,  and  that  a  most  careful 
and  repeated  volumetric  analysis  of  the 
urine,  in  every  possible  particular,  shows 


MEDICAL  CONSIDEEATIONS     69 

that  it  is  rarely  if  ever  that  of  health. 
This  latter  statement  does  not  refer  to 
the  presence  of  albumen  or  sugar,  which 
are  seldom  found,  but  to  the  many  in- 
gredients which  represent  the  ultimate 
result  of  tissue  metabolism. 

The  medical  treatment  of  cancer,  there- 
fore, opens  a  very  wide  field  of  observa- 
tion and  study,  and  the  applied  therapeu- 
tics in  different  cases  may  vary  very  wide- 
ly. But  with  the  steady  and  persistent 
aim  and  effort  to  rectify  metabolic  errors, 
and  properly  correct  disorders  of  elimina- 
tion by  diet,  hygiene,  and  proper  medica- 
tion, I  know  that  much  impression  can  be 
made  upon  the  morbidity  and  mortality 
of  cancer,  as  I  have  witnessed  in  private 
practice  for  forty  years,  in  large  numbers 
of  cases. 

My  time  is  up  and  I  must  stop;  but  I 
can  not  close  without  urging  you  to  accept 
my  views,  so  far  at  least  as  to  study  care- 
fully your  cancer  patient  from  a  medical 
standpoint,  and  not  think  that  the  only 


70  MEDICAL  ASPECTS  OF  CANCER 

possible  hope  is  in  the  surgical  removal  of 
the  product  or  result  of  a  systemic  condi- 
tion, which  in  the  end  carries  off  a  very 
large  proportion  of  its  victims,  under 
the  prevailing  views  in  regard  to  the  dis- 
ease. Eemember  also  that  the  earlier, 
the  more  earnestly,  faithfully  and  intelli- 
gently proper  medical  measures  are  car- 
ried out,  the  more  hope  and  expectation 
there  is  of  checking  the  disordered  blood 
and  cell  action  which  so  commonly  even- 
tuate in  death. 


CHAPTER    VI 

MEDICAL    ASPECTS    OF    CANCER* 

In  his  recent  president's  address  before 
the  American  Surgical  Association,  Dr. 
William  J.  Mayo  spoke  in  regard  to  the  in- 
ternal causation  of  cancer  in  a  manner 
which  shonld  attract  serions  attention. 
Few  have  had  a  wider  acquaintance  with 
the  surgical  aspects  of  the  disease  than  he, 
and  few  others  know  better  than  he  how 
relatively  impotent  surgical  procedures  are 
to  stay  the  steadily  increasing  mortality 
from  cancer,  which  now  claims  about  90 
per  cent,  of  those  whom  it  once  attacks. 

As  a  text  for  what  I  have  to  say,  I  want 
to  quote  a  few  of  his  words,  as  they  confirm 
so  strongly  the  views  I  have  held  and  by 
which  I  have  practised  for  thirty  years 


*  Address  before  the  Rhode  Island  Medical  Society, 
March  4.  1915. 

71 


72  MEDICAL  ASPECTS  OF  CANCER 

and  more,  with  results  which  I  have  sel- 
dom, if  ever,  had  cause  to  regret. 

Speaking  of  the  prophylaxis  of  cancer, 
mainly  from  its  surgical  aspects  in  regard 
to  early  operation,  Dr.  Mayo  says:  ^^ Can- 
cer of  the  stomach  forms  nearly  one-third 
of  all  cancers  of  the  human  body.  So  far 
as  I  know  this  is  not  true  of  the  lower  ani- 
mals, nor  of  uncivilized  man.  ...  Is 
it  not  possible,  therefore,  that  there  is 
something  in  the  habits  of  civilized  man,  in 
the  cooking  or  other  preparation  of  his 
food,  which  acts  to  produce  the  precancer- 
ous condition?  .  .  .  Within  the  last 
100  years  four  times  as  much  meat  is  taken 
as  before  that  time.  If  flesh  foods  are  not 
fully  broken  up,  decomposition  results  and 
active  poisons  are  thrown  into  an  organ 
not  intended  for  their  reception  and  which 
has  not  had  time  to  adapt  itself  to  the  new 
function.  ^ '  In  conclusion  he  says :  '  ^  Where 
cancer  in  the  human  is  frequent,  a  close 
study  of  the  habits  of  civilized  man  as 
contrasted  with  primitive  races  and  lower 


GENEEAL  RELATIONS  73 

animals,  where  similar  lesions  are  con- 
spicuously rare,  may  be  of  value,  and 
finally  the  prophylaxis  of  cancer  depends, 
first,  on  a  change  in  those  cancer-producing 
habits,  and  second,  on  the  early  removal  of 
all  precancerous  lesions  and  sources  of 
chronic  irritation. '  ^ 

I  shall  hope  to  show  you  that  cancer  is 
indeed  a  disease  of  modern  civilization, 
like  tuberculosis,  although  of  quite  a  dif- 
ferent nature,  and  that  the  increase  in  its 
prevalence  and  mortality  has  closely  fol- 
lowed the  habits  of  man,  in  regard  to  diet 
and  mode  of  life,  as  influenced  by  so-called 
civilization.  We  shall  see  that  as  the  death 
rate  of  tuberculosis  has  diminished,  that  of 
cancer  has  steadily  increased,  the  one  un- 
der improved  nutrition,  the  other  under  ex- 
cessive or  erroneous  nutrition. 

It  is  strange  that  the  medical  profession 
has  been  so  slow  in  accepting,  or  unwilling 
to  accept  and  act  upon  the  suggestions 
along  this  line  which  have  been  thrown 
out   from   time   to   time,   for   very  many 


74  MEDICAL  ASPECTS  OF  CANCER 

years,  by  surgeons  of  prominence,  who 
were  well  acquainted  with  cancer,  and  who 
felt  their  inability  to  cope  with  this  dis- 
tressing and  fatal  disease.  And  yet  in- 
numerable, earnest,  faithful,  and  intelli- 
gent research  workers  have  expended  any 
amount  of  time  and  labor,  countless  animal 
lives  have  been  sacrificed,  and  vast  sums 
of  money  have  been  spent  in  searching  for 
the  cause  of  malignant  disease,  with  little 
if  any  but  negative  results ;  from  the  stand- 
point of  laboratory  investigations  thus  far 
a  satisfactory  answer  as  to  the  problem  of 
cancer  seems  as  distant  as  ever,  with  no 
practical  suggestions  in  regard  to  the  pre- 
vention and  cure  of  the  malady,  except  by 
local  means,  including  surgery,  x-ray,  ra- 
dium, etc. 

From  the  surgical  aspect  the  problem 
does  not  seem  much  brighter,  as  we  shall 
see  later.  All  honor  to  the  surgeons  who 
have  so  earnestly  and  valiantly  striven  to 
cure  the  disease  by  these  means,  but  alas, 
their  efforts   have    proved   unavailing   to 


GENERAL  RELATIONS  75 

check  to  any  degree  the  constant  rise  in 
the  general  death  rate  from  cancer,  as 
shown  by  the  mortality  tables  from  many 
lands;  and  this  is  because  the  effort  has 
not  been  along  the  right  lines,  as  I  shall 
hope  to  show. 

I  am  well  aware  of  the  improvement  in 
surgical  statistics  which  has  been  reported 
in  regard  to  cancer  in  certain  localities 
during  the  last  few  years,  and  of  the  im- 
portance of  very  early  operations,  if  good 
results  are  to  be  obtained;  but  I  hope  also 
to  show  that  the  same  pertains  to  the  die- 
tetic and  medical  treatment  of  the  disease. 
While  operative  procedures  may  remove 
the  tumor,  and  with  it  the  source  of  toxic 
material  generated  in  the  same,  they  do 
not  in  any  way  affect  the  primeval  or  basic 
cause  of  the  trouble;  whereas,  if  exactly 
the  right  measures  are  employed  to  reach 
the  fundamental  source  of  the  dijSiculty, 
not  only  will  the  original  new  formation 
disappear  but  there  will  be  little  or  no 
tendencv  to  its  recurrence.     What  these 


76  MEDICAL  ASPECTS  OF  CANCER 

lines  of  causation  are  will  appear  later. 

Dietetic  and  medical  treatment  of  cancer, 
in  the  fullest  sense,  have  never  been  given 
a  fair  and  completely  intelligent  trial,  on  a 
scale  large  enough  to  produce  general  con- 
viction in  regard  to  their  value  and  to  lead 
to  their  general  adoption.  With  a  rather 
extended  experience  during  the  last  forty 
years,  I  have  rarely  if  ever  found  a  patient 
with  cancer  who  has  received  adequate  and 
continuous  medical  care  and  treatment  be- 
fore operation,  with  a  view  of  discovering 
and  rectifying  the  cause  of  the  morbid 
growth.  Too  often  when  a  cancer  is  sus- 
pected or  discovered  it  is  taken  as  a  fore- 
gone conclusion  that  the  malady  is  hope- 
less, except  as  the  restilts  of  the  disease, 
that  is  the  new  growth,  may  be  removed  by 
the  knife,  x-ray,  radium,  caustics,  etc. 

Also  after  a  surgical  operation,  as  far  as 
my  observation  goes,  the  patients  are  in- 
variably left  entirely  to  their  own  re- 
sources, with  the  hope,  alas,  too  often  fu- 
tile, that  the  tumor  will  not  regrow,  but 


GENERAL  RELATIONS  77 

with  no  attempt  to  so  guide  the  life  that 
there  shall  not  be  the  same  tendency  to  a 
recurrent  malignant  new  formation  as  be- 
fore. Against  this  latter  course  I  also 
raise  my  earnest  protest. 

That  you  may  know  that  Dr.  Mayo  is  not 
alone  in  his  impressions  that  there  is 
**  something  in  the  habits  of  civilized  man 
.  .  .  which  acts  to  produce  the  precan- 
cerous condition,''  I  must  very  briefly  re- 
fer to  some  of  the  leading  surgeons  of  the 
past  who,  from  time  to  time,  with  more  or 
less  force,  have  claimed  that  the  disease  is 
constitutional,  and  that  it  depends  largely 
on  diet  and  mode  of  life :  later  I  shall  hope 
to  present  sound  grounds  for  such  belief. 

One  hundred  years  ago  Lambe  wrote 
clearly  in  regard  to  the  causation  of  can- 
cer from  luxurious  living,  and  adduced 
strong  proof  to  show  the  effect  of  diet  in 
curing  certain  cases  of  undoubted  cancer 
of  the  breast  and  uterus. 

Abernethy,  shortly  after,  wrote  point- 
edly regarding  the  constitutional  origin  of 


78  MEDICAL  ASPECTS  OF  CANCER 

tumors,  endorsing  Lambe's  dietetic  treat- 
ment of  cancer  and  presenting  several  rea- 
sons why  it  should  be  fairly  tried. 

Walshe  in  his  classical  work  on  cancer, 
says,  ''It  would  in  theory  appear  that  the 
removal  of  a  tumor  cannot  in  itself  cure 
the  disease,  as  the  local  formation  is  but  a 
symptom  of  the  general  vice  of  the  econ- 
omy,'^ and  he  alludes  more  or  less  to  the 
effect  of  diet  on  the  disease. 

The  late  Willard  Parker,  one  of  New 
York's  great  surgeons,  in  a  study  of  397 
cases  of  cancer  of  the  breast,  observed  from 
1830  to  1880,  wrote  very  strongly  in  regard 
to  the  constitutional  relations  of  cancer. 
In  considering  its  etiology  he  places  first 
**  luxurious  living  and  particularly  excess 
in  animal  food. ' '  He  says,  ' '  Cancer  is  to  a 
great  degree  one  of  the  final  results  of  a 
long-continued  course  of  error  in  diet,  and 
a  strict  dietetic  regimen  is,  therefore,  the 
chief  factor  in  the  treatment,  preventative 
and  curative. '^  He  further  says,  ''In  re- 
gard to  the  effect  of  abstemiousness  on  can- 


GENERAL  RELATIONS  79 

cer  I  can  speak  with  great  positiveness, 
that  vegetable,  or  at  least  a  very  bland 
diet,  does  check  the  progress  of  the  dis- 
ease, and  in  some  cases  now  under  treat- 
ment has  been  attended  by  an  alleviation 
of  symptoms ;  and  in  a  few  instances  even 
by  a  recession  of  the  growth." 

Sir  Astley  Cooper  is  quoted  by  Dr.  Par- 
ker in  some  strong  language,  as  follows: 
*'The  cause  of  this  disease  is  supposed  to 
be  some  accidental  blow  or  the  pressure  of 
a  part  of  the  dress ;  but  although  the  blow 
may  produce  a  swelling  on  the  bosom,  yet 
that  swelling  will  not  be  of  a  schirrous  na- 
ture unless  some  defective  state  of  the  con- 
stitution disposes  to  malignant  action.  If 
the  constitution  be  good  the  effects  of  the 
blow  are  speedily  dissipated:  but  if  the 
constitution  be  faulty,  the  swelling  grows 
into  a  formidable  disease. ' '  Later  we  shall 
see  what  some  of  these  constitutional  con- 
ditions are  which  induce  certain  cells  of  the 
body  to  take  on  malignant  action. 

Sir  James  Paget,  that  prince  of  surgeons 


80  MEDICAL  ASPECTS  OF  CANCER 

and  pathologists,  comes  out  very  strongly 
for  the  constitutional  origin  of  cancer  when 
he  says  twice  in  his  Lectures  on  Surgical 
Pathology  that  cancers  are  **  local  manifes- 
tations of  certain  specific  morbid  states  of 
the  blood";  and  again,  he  says,  *^I  believe 
it  to  be  constitutional,  in  the  sense  of  hav- 
ing its  origin  and  chief  support  in  the  blood 

.  .  .  the  existence  of  the  morbid  mate- 
rial in  the  blood,  whether  in  the  rudimental 
or  effective  state,  constitutes  the  general 
predisposition  to  cancer." 

Benecke,  in  1875,  elaborated  a  diet  highly 
beneficial  in  cancer,  which  was  endorsed  by 
Esmarck  and  Oldehop. 

If  time  permitted  I  could  give  any 
amount  of  further  corroborative  evidence, 
in  the  way  of  scattered  remarks  and  allu- 
sions, like  those  of  Dr.  Mayo,  expressing 
the  conviction  of  many  others,  that  cancer 
is  not  a  purely  local  affection,  but  is  only 
the  result  of  some  previous  systemic  dis- 
turbance, which  we  now  recognize  as  met- 
abolic. 


GENEEAL  EELATIONS  81 

But  these  many  fugitive  observations 
have  never  attracted  the  attention  they  de- 
serve, and  it  would  sometimes  seem  as  if 
they  were  deliberately  ignored,  and  that 
scientists  and  practitioners  had  combined 
to  recognize  only  the  local  nature  and 
treatment  of  cancer.  The  truth  is  that  very 
little  serious  effort  has  ever  been  made  to 
assemble  all  the  evidence  of  the  constitu- 
tional nature  of  the  disease,  and  by  synthe- 
sis and  deduction  to  establish  a  basis  for 
the  recognition  and  treatment  of  the  consti- 
tutional elements  of  cancer.  While  it  has 
been  impossible  to  gather  all  the  proof 
that  could  be  desired,  I  shall  hope  to  give 
enough  to  establish  the  correctness  of  the 
basis  of  the  thesis  which  I  have  long  held. 

Cancer  is  more  or  less  widely  diffused 
over  the  whole  globe,  but  in  singularly  dif- 
ferent degrees  in  various  sections,  and  time 
will  permit  of  only  the  briefest  statement 
of  the  same,  which  can  be  verified  and  ex- 
panded from  the  remarkable  recent  works 
of  Williams  and  Wolff. 


82  MEDICAL  ASPECTS  OF  CANCER 

Thus  in  England  cancer  mortality  is 
very  high,  and  during  the  past  40  or  50 
years  it  has  increased  four  or  five  fold, 
while  the  population  has  only  a  little  more 
than  doubled.  Switzerland  is  credited  with 
having  the  highest  death  rate  from  cancer 
of  any  country,  it  having  augmented  from 
114  per  100,000  living  in  1889  to  132  in 
1898.  Denmark  stands  next  with  130  per 
100,000  living  in  1900,  and  France  has  a 
high  cancer  mortality,  with  a  constantly 
increasing  death  rate.  In  Paris  it  has  in- 
creased from  84  per  100,000  living  in  1865 
to  120  in  1900.  In  Holland,  the  death  rate 
from  1867-1879  was  49  per  100,000,  and 
101  in  1905. 

The  United  States  shows  a  lower  death 
rate  from  cancer  than  the  countries  men- 
tioned, namely  78.9  per  100,000  living  in  the 
registration  area  in  1913;  but  it  had  in- 
creased from  63  in  1900,  over  25  per  cent., 
while  deaths  from  tuberculosis  had  fallen 
a  little  over  25  per  cent. :  in  1913  there  were 
over   50,000   deaths    from   cancer   in   the 


GENERAL  RELATIONS  83 

United  States.  In  a  recent  study  regarding 
New  York,  Boston,  Pittsburgh,  Baltimore, 
CMcago,  Philadelphia,  and  St.  Louis,  it  was 
found  that  there  had  been  an  increase  of 
almost  8  per  cent,  of  deaths  from  cancer 
in  their  combined  population  in  1913,  as 
compared  with  the  average  of  the  five  years 
preceding. 

I  am  quite  aware  that  some  have  claimed 
that  the  increase  of  death  from  cancer  is 
only  apparent,  and  not  real,  and  is  account- 
ed for  by  a  greater  longevity  into  the  can- 
cer age,  by  more  accurate  diagnosis,  and  by 
greater  exactness  in  recording  deaths.  But 
these  points  have  been  carefully  and  sat- 
isfactorily refuted  by  Williams,  and  surely 
the  increase  of  8  per  cent,  in  these  seven 
cities  could  not  be  thus  accounted  for.  In 
New  York  City,  according  to  the  Weekly 
Bulletins  of  the  Board  of  Health,  there 
were  2173  deaths  from  cancer  in  the  six 
months  from  May  to  November,  1914,  or 
almost  twelve  deaths  daily  from  malignant 
disease. 


84  MEDICAL  ASPECTS  OF  CANCER 

While  cancer  is  steadily  increasing 
everywhere,  under  the  influence  of  modem 
civilization,  there  are  certain  sections 
where  the  mortality  is  much  lower  than  has 
been  mentioned. 

Thus  Italy  has  a  low  but  increasing  mor- 
tality, it  having  risen  from  20  per  100,000 
living  in  1880  to  58  in  1905.  Hungary  had 
a  cancer  death  rate  of  26  in  1897  and  39 
in  1903;  in  the  county  of  Kerry,  Ireland, 
the  cancer  death  rate  was  26  and  in  the 
province  of  Dalmatia  16  per  100,000  living 
population. 

In  some  regions,  however,  cancer  is  very 
rare  and  in  others  almost  unknown.  In 
Africa  all  observers  agree  that  the  disease 
is  exceedingly  rare,  as  also  among  those 
in  the  interior  of  China  and  India ;  in  Bra- 
zil it  is  seldom  seen,  while  several  testify 
that  in  many  of  the  islands  of  the  sea  it  is 
practically  unknown. 

During  a  rather  extensive  trip  through 
the  Far  East  I  was  unable  to  see  or  hear 
of  any  cancer,  although  I  met  a  large  num- 


GENERAL  RELATIONS  85 

ber  of  medical  men,  and  made  diligent  in- 
quiry regarding  the  same.  I  visited  very 
many  civil,  military,  and  mission  hospitals, 
with  a  total  of  many  thousands  of  patients, 
and  ministering  to  many  millions  of  popu- 
lation :  in  Japan,  Korea,  China,  the  Philip- 
pines, India,  Siam,  and  Egypt,  I  met  the 
same  response,  that  cancer  was  very  rarely 
seen  among  the  natives. 

Now  there  must  be  some  reason  for  this 
unequal  distribution  of  cancer.  Labora- 
tory researches  have  not  helped  us  in  dis- 
covering it,  except  that  they  have  done 
much  to  clear  the  way  for  a  proper  under- 
standing of  the  real  nature  and  cause  of 
cancer,  though  the  evidence  furnished  is 
largely  of  a  negative  character.  In  order 
to  appreciate  fully  the  basis  on  which  our 
thesis  rests,  it  will  be  well  to  state  very 
briefly  the  accepted  facts  in  regard  to  can- 
cer. 

1.  Cancer  is  but  a  deviation  from  the 
normal  life  and  action  of  certain  of  the  or- 
dinary cells  of  the  body. 


86  MEDICAL  ASPECTS  OF  CANCER 

2.  It  is  possible  that  the  diseased  action 
may  begin  first  in  what  is  known  as  '^em- 
br^^onic  rests/ ^  or  prenatal,  wrongly 
placed  tissue  elements. 

3.  Cancer  is  not  wholly  of  traumatic  ori- 
gin. 

4.  It  is  not  caused  by  a  micro-organism, 
or  parasite. 

5.  Cancer  is  not  contagious. 

6.  Cancer  i^not  hereditary  in  any  appre- 
ciable degree. 

7.  Occupation  has  not  any  great  influ- 
ence on  the  occurrence  of  cancer. 

8.  Cancer  is  not  altogether  a  disease  of 
old  age. 

9.  It  does  not  especially  belong  to  or  af- 
fect any  particular  sex,  race,  or  class  of 
persons. 

10.  Cancer  is  not  confined  to  any  loca- 
tion or  section  of  the  earth. 

11.  No  single  cause  of  cancer  has  yet 
been  demonstrated,  nor  is  it  likely  that  this 
will  ever  be  the  case,  as  the  experimental 


GENERAL  RELATIONS  87 

and  other  investigations  have  covered  al- 
most every  possible  line  of  research,  with 
only  negative  results. 

But  there  must  be  some  cause,  or  reason, 
why  cancer  is  thus  unevenly  distributed 
and  why  it  is  so  steadily  increasing  al- 
most everywhere ;  why  it  is  so  exceedingly 
prevalent  in  some  localities  and  among 
certain  peoples,  and  again  so  rare  or  even 
absent  among  others;  for  we  have  seen 
that  aborigines  are  not  affected,  while  oth- 
ers, in  proportion  as  they  have  been  af- 
fected by  so-called  civilization  are  corre- 
spondingly affected.  Wolff  has  shown  in 
a  remarkable  table,  that  while  cancer  in 
the  native  Australians  has  remained  about 
stationary,  it  has  increased  among  the  Eng- 
lish residents  in  cities  seven  fold,  and  an- 
other Avriter  remarks  that  while  the  native 
Australians  are  practically  free  from  the 
disease,  when  they  mingle  with  foreigners 
as  servants  and  employees  and  adopt  their 
diet  and  customs  it  occurs  more  frequently 
among  them.    The  same  has  been  observed 


88  MEDICAL  ASPECTS  OF  CANCER 

among  native  Africans  and  those  in  India 
and  elsewhere. 

Analyzing  the  various  data  obtained,  we 
find  that  cancer  has  increased  in  proportion 
to  the  consumption  of  the  three  articles, 
meat,  coffee  and  tea,  and  alcohol. 

In  England,  where  the  consumption  of 
meat  has  doubled  during  the  past  50  years 
and  recently  was  130  pounds  per  capita 
yearly,  cancer  mortality  has  increased  four 
fold.  In  Italy,  where  the  consumption  of 
meat  is  the  least  of  any  of  the  European 
countries,  cancer  is  least  frequent,  and  in 
the  county  of  Kerry,  Ireland,  where  meat 
is  seldom  eaten,  the  death  rate  from  can- 
cer is  not  one-third  that  in  England.  The 
same  comparison  may  be  made  between  a 
number  of  other  countries,  did  time  permit. 
The  United  States  in  1909  consumed  much 
more  meat  than  England,  namely  172 
pounds  per  capita,  and,  as  already  stated, 
cancer  has  increased  over  25  per  cent,  since 
1900. 

Alcohol  must  also  be  accredited  with  a 


GENERAL  RELATIONS  89 

portion  of  the  increase  of  cancer  in  both 
these  countries,  as  it  is  well  known  that  the 
disease  presents  a  far  greater  augmenta- 
tion in  those  occupations  where  alcoholic 
drinks  are  indulged  in,  as  in  bartenders, 
printers,  and  others. 

Coffee  has  been  shown  to  have  its  largest 
per  capita  consumption  in  Holland,  where 
the  cancer  death  rate  is  among  the  highest, 
while  Hungary  is  the  smallest  consumer  of 
coffee,  and  the  cancer  mortality  there  is 
among  the  lowest,  namely  39  per  100,000 
living.  The  people  of  the  United  States 
consume  one-third  of  all  the  coffee  pro- 
duced, more  than  Germany,  Austria,  Hun- 
gary, France,  and  the  United  Kingdom 
combined.  England  and  her  colonies,  where 
cancer  is  steadily  increasing,  consume  one- 
half  of  the  world  *s  output  of  tea. 

Williams  has  given  some  interesting  and 
important  data  regarding  the  effect  of 
prosperity  and  wealth,  leading  to  self-in- 
dulgence and  indolence,  in  the  augmenta- 
tion of  cancer  mortality,  which  time  does 


90  MEDICAL  ASPECTS  OF  CANCER 

not  permit  our  long  dwelling  upon.  He 
shows  clearly  that  as  these  elements  of 
modern  civilization  have  developed,  cancer 
has  surely  increased,  and  he  gives  striking 
illustrations  of  the  same.  In  England  it 
was  found  in  one  decennium  that  cancer 
mortality  was  more  than  twice  as  great 
among  well-to-do  men,  having  no  specific 
occupation,  as  among  occupied  males  in 
general,  the  ratio  being  96  to  44. 

Nerve  conditions  have  also  been  found 
by  many  to  be  an  important  element  in  the 
production  of  cancer,  and  the  very  great 
nervous  strain  accompanying  modern  civ- 
ilization must  be  reckoned  among  its  causa- 
tive factors,  possibly  through  its  effect  on 
metabolism. 

To  understand  how  these  various  ele- 
ments mentioned,  and  probably  others, 
have  an  influence  in  the  genesis  of  cancer 
we  must  briefly  consider  the  physiology  of 
nutrition  and  the  metabolism  of  cancer  as 
far  as  it  has  been  ascertained. 

All  recognize,  of  course,  that  the  body 


GENERAL  RELATIONS  91 

nutrition,  in  health  and  disease,  depends 
upon  the  nutritive  elements  taken  into  the 
system,  as  proteids,  carbohydrates,  and 
fats,  with  oxygen  inhaled  and  water  im- 
bibed. We  know,  of  course,  that  there  is 
a  certain  equilibrium  to  be  maintained  in 
regard  to  its  various  component  parts,  and 
that  over-indulgence  in  certain  articles  can 
without  doubt  produce  disease  as,  for  in- 
stance, acute  or  chronic  gout  from  free  in- 
dulgence in  Port  and  Madeira  wine.  Just 
where  the  fault  lies,  and  why  after  a  cer- 
tain time  the  system  rebels  and  refuses  to 
properly  metabolize  and  remove  waste 
products,  or  why  the  latter  exert  such  a 
baneful  influence  on  different  portions  of 
the  economy,  and  give  rise  to  various  in- 
flammations and  misgrowths,  is  hard  to 
tell,  and  must  be  the  subject  of  future 
study,  but  the  fact  no  thinking  man  can 
doubt.  Later  we  shall  hope  to  throw  some 
little  light  upon  it. 

The  metabolism  of  cancer  has  been  the 
subject  of  considerable  research,  and  there 


92  MEDICAL  ASPECTS  OF  CANCER 

have  been  many  reports  in  this  direction 
which  can  be  but  briefly  alluded  to  here; 
unfortunately,  however,  most  of  these  in- 
vestigations have  been  made  upon  ad- 
vanced cases,  where  the  system  has  been 
already  depressed  by  the  poisonous  toxins 
produced  in  the  already  well-developed 
cancer  mass,  or  where  the  disease  process 
has  already  involved  important  viscera  and 
interfered  with  their  proper  action.  What 
we  need  is  careful  metabolic  studies  on  pre- 
cancerous states  of  relative  health,  also  in 
very  early  cancer,  and  likewise  after  sur- 
gical operations,  when  the  local  manifes- 
tations of  the  disease  have  been  removed; 
only  thus  can  we  rightly  learn  the  true 
errors  of  metabolism  which  lead  up  to  can- 
cer. 

But  enough  has  been  developed  to  show 
that  the  cancerous  person  manifests  grave 
aberrations  from  the  normal  state,  other 
than  the  local  tumor. 

The  blood  exhibits  great  changes  in  can- 
cer, especially  toward  the  end  of  the  dis- 


GENERAL  RELATIONS  93 

ease.  The  hemoglobin  content  tends  to 
constantly  fall,  and  the  red  cells  to  dimin- 
ish, and  to  exhibit  various  phases  of  de- 
generation. The  white  cells  increase,  and 
the  proportion  of  their  varieties  changes 
greatly.  Unfortunately  the  plasma  has  not 
been  much  studied,  and  yet  the  condition 
of  this  fluid  must  be  of  the  utmost  impor- 
tance, as  from  it  are  derived  not  only  the 
solid  constituents  of  the  blood  but  also 
those  of  the  entire  system.  It  also  holds 
in  solution  the  phosphates,  carbonates,  sul- 
phates, and  chlorides,  the  latter  often  vary- 
ing greatly  and  being  chiefly  responsible 
for  the  isotonic  relation  of  cells  and  serum. 
In  cancerous  cachexia  a  diminution  of  car- 
bonic acid,  a  constantly  diminished  alka- 
linity, and  an  increase  of  acid  principles  of 
the  blood  have  been  fully  demonstrated, 
pointing  in  all  probability  to  an  acid  intox- 
ication. It  seems  that  the  toxic  secretion 
from  a  cancerous  mass  itself  has  a  dis- 
tinctly injurious  action  on  the  blood,  for 
after  the  complete  removal  of  a  cancerous 


94  MEDICAL  ASPECTS  OF  CANCER 

mass  there  is  often  found  an  increase  of 
hemoglobin,  as  I  have  witnessed,  and  a 
high  leucocytosis  has  disappeared  after  the 
removal  of  schirrus  of  the  breast,  only  to 
return  again  with  the  recurrence  of  the  tu- 
mor. 

The  uri/ne  in  cancer  has  also  been  much 
studied,  and  is  rarely  if  ever  found  to  be 
that  of  health,  although  it  cannot  be  said 
that  any  definite  and  specific  changes  have 
been  established  which  are  pathognomonic 
of  the  disease:  the  urinary  excretion  will 
constantly  be  found  to  be  extremely  defi- 
cient, both  as  to  its  quantity  and  its  total 
solid  elimination.  In  one  very  interesting 
case  of  primary  cancer  of  the  breast,  in 
a  stout,  flabby  lady,  near  55,  in  private 
practice,  the  total  quantity  of  urine,  meas- 
ured daily  for  weeks,  is  always  very  far 
below  the  normal  amount,  and  in  spite  of 
active  medication  it  seems  almost  impos- 
sible to  raise  the  total  daily  solids  excreted 
in  the  urine,  to  much  more  than  one-half 
of  that  called  for  by  the  weight  of  the 


GENERAL  RELATIONS  95 

patient.  This  I  have  observed  in  very 
many  cases. 

Li  regard  to  the  changes  which  have  been 
reported  in  the  urine  of  cancer  patients, 
many  observers  agree  that  there  is  a  dis- 
turbance of  proteid  metabolism,  and  de- 
pendent upon  this  many  deviations  from 
normal  are  found  in  the  urine.  The  urea 
is  invariably  diminished,  often  very  great- 
ly, as  I  have  verified  time  and  again  in 
many  cases.  The  nitrogen  partition  is 
greatly  disturbed,  with  increase  in  colloid 
nitrogen  to  more  than  double  the  normal 
amount,  and  an  increased  elimination  of 
xanthin,  oxyproteic  acid,  and  urinary  am- 
monia; oxyproteic  acids  are  reported  by 
Blumenthal  as  increased  even  in  very  early 
cancer,  and  independently  of  the  size  of 
the  tumor  and  degree  of  cachexia,  seeming- 
ly showing  them  to  have  some  specificity 
for  cancer,  because  they  have  not  been 
found  in  other  forms  of  malignancy. 

Notable  changes  have  also  been  recorded 
concerning   the    sulphur   elements   in   the 


96  MEDICAL  ASPECTS  OF  CANCER 

urine,  with  a  great  increase  in  neutral  (un- 
oxidized)  sulphur,  and  a  considerable  ex- 
cess of  sulpho-cyanic  acid,  together  with  an 
increase  in  sulphates  and  indican,  showing 
the  results  of  intestinal  fermentation  of 
protein  elements,  which  I  have  also  con- 
stantly observed.  There  have  been  like- 
wise other  changes  reported,  which  time 
forbids  our  considering. 

The  saliva  is  an  important  element  in 
the  digestion  of  carbohydrates,  and  conse- 
quently in  metabolism  and  the  genesis  of 
cancer ;  but,  unfortunately,  I  have  not  been 
able  to  find  any  investigations  relating  to 
its  condition  in  this  disease.  But  in  very 
many  tests  which  I  have  made  in  cancer 
patients  it  is  commonly  found  acid,  often 
strongly  so ;  in  my  hospital  cases  I  have  it 
tested  before  and  after  each  meal,  and 
watch  with  considerable  interest  its  change 
to  alkaline  under  efficient  treatment,  which 
includes  prolonged  mastication. 

The  internal  secretions  have  also  been 
the  subject  of  much  research  and  specula- 


GENERAL  RELATIONS  97 

lion  of  late  years,  in  regard  to  their  influ- 
ence on  metabolism  and  the  life  processes 
of  the  economy,  and  some  studies  have  been 
made  concerning  their  connection  with  can- 
cer, which  cannot  now  be  long  dwelt  upon. 
But  there  seems  to  be  little  doubt  but  that 
the  secretions  of  the  ductless  glands  in 
common  have  much  to  do  with  regulating 
the  metabolism  of  the  body  cells.  We  know 
for  instance,  that  disease  of  the  pituitary 
body  produces  bone  disorder,  resulting  in 
gigantism,  that  thyroid  derangement  re- 
sults in  myxedema,  and  that  disease  of  the 
suprarenal  capsules  gives  rise  to  Addison's 
disease,  or  bronzed  skin.  May  we  not 
rightly  argue  that  derangement  in  one  or 
more  of  these  has  something  to  do  with  the 
cellular  changes  which  we  call  cancer?  The 
favorable  results  which  have  attended  the 
administration  of  thyroid,  which  I  have 
myself  often  witnessed,  as  also  a  combina- 
tion of  the  three  extracts,  as  reported  by 
some,  would  seem  to  confirm  this. 

The  pancreatic  secretion  performs  un- 


98  MEDICAL  ASPECTS  OF  CANCER 

doubtedly  an  important  part  in  metabolism, 
and  although  some  researches  have  seemed 
to  show  that  Beard's  claim  for  it  in  cancer 
was  not  well  founded,  the  matter  should  be 
again  investigated,  possibly  along  the  diet- 
ary line  herein  considered. 

Very  much  more  could  be  given  in  regard 
to  the  metabolism  of  cancer,  did  time  per- 
mit, but  enough  has  been  said  to  show  that 
there  are  gross  perturbations  of  the  system 
connected  with  this  disease,  and  that  the 
local  tumor  is  but  an  expression  of  one 
aspect  of  a  constitutional  disorder,  which 
if  unchecked  tends  to  death,  aided  undoubt- 
edly by  a  virulent  poison  secreted  by  the 
malignant  cells  of  the  tumor,  when  it  has 
once  developed. 

Everything  has  its  beginning,  but,  as  Ri- 
bert  says,  *  *  no  one  has  ever  seen  the  begin- 
nings of  mammary  cancer,  *'  nor  of  any 
other  malignant  lesion,  and  we  are  in  utter 
ignorance  of  the  first  change  which  takes 
place  when  a  cell  or  cells  take  on  a  rampant 
or   malignant   action.     But    whenever    or 


GENERAL  RELATIONS  99 

however  it  takes  place  the  impetus  must  be 
from  the  plasma  bathing  the  cell  which  was 
previously  normal  and  innocent.  We  have 
not  time  to  discuss  the  subject  of  "embry- 
onic rests,''  which  quite  possibly  have  to 
do  with  the  genesis  of  the  disease.  But 
these  are  now  known  to  be  common  ana- 
tomical or  histological  elements,  many  of 
which  are  present  in  every  one,  and  which 
are  ordinarily  quite  harmless.  It  is,  there- 
fore, quite  unreasonable  to  ascribe  the 
cause  of  cancer  to  them  alone — there  must 
be  some  deeper,  underlying  cause  which  ex- 
cites them  to  take  on  and  continue  malig- 
nant action,  and  that  cause  is  found  in  the 
perverted  blood  and  lymph  stream  result- 
ing, as  several  writers  have  affirmed,  from 
a  prolonged  violation  of  the  laws  of  perfect 
health,  although  other  evidence  of  this  may 
not  have  been  previously  recognized  in 
the  individual  patient. 

It  is  more  than  probable  that  a  local  ir- 
ritant is  the  exciting  cause  of  the  starting 
up  of  the  aberrant  action  of  some  partieu- 


100  MEDICAL  ASPECTS  OF  CANCER 

Jar  cell  or  cells.  These  then  go  on  multi- 
plying inordinately,  destroying  adjacent 
tissues,  and  finally  break  down,  instead  of 
forming  normal  tissue.  But  the  local  irri- 
tant cannot  explain  why,  when  once  started 
by  local  injury,  the  cells  should  pursue  such 
a  progressive,  aggressive,  and  invasive 
course.  The  reason  is  found,  as  Sir  Astley 
Cooper  and  others  have  believed,  in  some 
faulty  condition  of  the  system,  which  is 
now  shown  to  be  from  a  perverted  metab- 
olism, arising  from  many  causes,  and 
among  others  from  over-indulgence  in  an- 
imal protein,  coffee  and  tea,  and  alcohol. 

It  would  seem,  therefore,  that  for  the 
development  of  the  local  manifestation  of 
cancer  (the  tumor  or  new  growth)  three 
elements  are  requisite,  namely:  1.  A  pre- 
disposition or  suitable  blood  condition.  2. 
A  local  stimulation  or  irritation  of  the  part 
affected,  upo7i,  3.  The  site  of  an  ^^embry- 
onic rest." 

In  but  a  relatively  small  proportion  of 
cases  can  the  direct  local  irritant  be  made 


GENERAL  RELATIONS         101 

out  with  certainty,  and  even  in  cancer  of 
external  parts,  as  the  breast,  there  is  often 
no  consciousness  of  external  injuiy  or  even 
a  blow,  while  in  cancer  of  internal  parts 
this  is  very  seldom  recognized.  I  am  quite 
aware  that  cancer  may  follow  gastric  ulcer, 
that  gall  stones  may  act  as  an  exciting 
cause,  and  fecal  impactions  in  intestinal 
diverticula  are  the  starting-point  of  can- 
cer, etc.  But  the  relative  rarity  of  such 
occurrences  shows  that  there  must  be  some 
hidden,  underlying,  constitutional  cause 
which  feeds  the  deranged  cells.  I  appre- 
ciate, also,  the  part  which  metastasis  plays 
in  spreading  the  disease  to  distant  parts, 
but  this  is  because  generally  the  faulty  met- 
abolic cause  is  allow^ed  to  continue,  for 
when  this  is  checked  by  proper  dietary  and 
other  treatment  even  metastatic  foci  disap- 
pear. 

We  come  now  to  the  question  as  to  what 
this  metabolic  disorder  is  which  incites  for- 
merly normal  tissue  cells  to  take  on  and 
continue  this  diseased  action,  which  is  real- 


102  MEDICAL  ASPECTS  OF  CANCER 

ly  the  true  problem  in  cancer.  Alas,  the  ac- 
tual and  exact  state  of  blood  which  leads 
up  to  the  disease  has  not  yet  been  fully  de- 
termined, although  all  that  has  been 
learned  and  already  briefly  alluded  to 
under  the  metabolism  in  cancer,  points 
clearly  to  the  lines  of  study  which  should 
be  more  closely  followed.  And  even  if  we 
should  be  long  in  establishing  a  definite  and 
true  metabolic  disorder,  or  should  never 
determine  it,  this  should  not  deter  us  from 
acting  on  clinical  grounds,  from  experience, 
even  as  is  constantly  done  in  regard  to 
many  other  ailments,  illustrations  of  which 
will  readily  occur  to  every  one.  Indeed, 
how  constantly  diseases  are  treated  em- 
pirically, with  greater  or  less  success,  with- 
out any  great  knowledge  of  their  real  eti- 
ology. 

Coming  now  to  the  important  question 
of  the  prophylaxis  and  treatment  of  can- 
cer to  which  this  study  of  its  medical  as- 
pects leads,  we  find  that  we  have  advanced 
far  toward  a  proper  understanding  of  the 


GENERAL  RELATIONS        103 

same.  We  have  seen  that  cancer  is  but  a 
wrong  development  of  certain  previously 
normal  body  cells,  possibly  "embryonic 
rests,''  by  a  process  of  agamogenesis,  de- 
pendent upon  excessive  and  faulty  nutri- 
tion. Laboratory  and  other  studies  have 
decided  pretty  certainly  that  it  is  not  due 
to  a  parasite,  nor  contagious,  that  it  is  not 
hereditary,  nor  due  wholly  to  local  irritant 
action,  that  it  is  not  altogether  a  disease 
of  old  age,  nor  belonging  to  any  particular 
occupation,  and  that  it  does  not  affect  any 
particular  sex,  race,  or  class  of  persons, 
and  that  it  occurs  all  over  the  earth,  but 
with  striking  difference  in  frequency  ac- 
cording to  certain  peculiarities  of  life,  as- 
sociated with  advancing  civilization.  We 
have  been  thus  forced,  by  exclusion,  to  rec- 
ognize that  it  must  be  due  to  some  sys- 
temic change,  whereby  the  perverted  nutri- 
tion offered  to  certain  irritated  cells  causes 
them  to  take  on  a  morbid  action,  which  is 
prolonged  by  a  continued  malnutrition, 
and  increased  or  aggravated  by  a  vicious 


104  MEDICAL  ASPECTS  OF  CANCER 

secretion  from  these  diseased  cells  them- 
selves; in  other  words,  that  it  is  a  disease 
of  faulty  metabolism. 

It  will  be  interesting  and  instructive  to 
consider  for  a  moment  some  of  the  other 
diseases  which  are  also  causing  a  constant- 
ly increasing  mortality,  as  shown  by  the  ac- 
companying table,  taken  from  the  volume 
of  the  United  States  Mortality  Statistics. 
These  are  all  recognized  as  due  to  faulty 
metabolism,  induced  b}^  advancing  so-called 
civilization. 

It  is  seen  here  that  while  the  death  rate 
from  infectious  diseases,  tuberculosis  and 
pneumonia,  has  declined  steadily  and  rap- 
idly, that  of  organic  heart  diseases  has 
risen  greatly,  and  nephritis  has  shown  a 
steady  rise,  as  also  apoplexy.  This  latter 
has  about  kept  pace  with  cancer,  which  has 
risen  from  63  deaths  per  100,000  living  in 
1900  to  78.9  in  1913,  a  gain  of  15.9  per 
100,000  in  13  3^ears,  or  over  25  per  cent. 

If  we  accept  the  fact  that  the  mortality 
of  these  diseases  is  steadily  rising  from 


GENERAL  RELATIONS 


105 


1900  i9oi  eoimi  1904  i«i05  igot,  mi  m  m  m  m  t^ii  m 


zio 


2.00 

190 

c 
o 

1^0 

■^ 

iVO 

3 

i60 

o_ 

^ 

150 

O 

o 

140 

8- 

130 

o 

i^O 

i- 

Q_ 

/ia 

iOO 

ri 

p:^ 

90 

■^ 

80 

p 

70 

6C 

50 

%. 

'% 

% 

/ 

^ 

^ 

s 

'^ 

^ 

\ 

\ 

\ 

^"n 

/ 

% 

\ 

N 

— ■ 

/ 

V 

0. 

/ 

\ 

. 

^ 

No 

/ 

--- 

/y 

\ 



r<^ 

\ 

^ 

*-,v 

A 

r 

\ 

\ 

X^ 

^>- 

1.  ^ 

N. 

/ 

— 

;.?^ 

'^ 

V 

\ 

-^ 

—\ 

T 

^^>u 

^.'^ 

_— 

=^ 

-^ 

^- 

,. — 

z:::! 

=< 

sef^ 

^ 

£10 

(SO 
ISO 
/70 
/60 
/50 
/40 
(30 
igX) 
110 
\00 
90 
80 
70 
60 
50 


Organic  heart  disease,  nephritis,  and  apoplexy  show 
a  continual  and  great  rise  in  mortality,  and  cancer 
has  a  coincident  rise  of  over  25  per  cent.  As  the 
three  former  are  recognized  to  he  largely  due  to  the 
incidents  of  modern  civilization,  mainly  in  the  line  of 
erroneous  eating  and  drinking,  it  would  seem  reason- 
able to  ascribe  cancer  to  the  same  cause. 


106  MEDICAL  ASPECTS  OF  CANCER 

the  effect  of  modern  civilization,  we  must 
also  admit  that  cancer,  whose  mortality  is 
increasing  coincidently,  is  due  to  the  same 
cause.  And  as  these  diseases  are  recog- 
nized to  be  largely  the  result  of  erroneous 
eating  and  drinking,  we  find  here  a  cor- 
roboration of  the  claims  now  set  forth  in 
regard  to  cancer.  It  seems  incredible  that 
the  profession  has  so  long  ignored  or  re- 
jected the  facts  showing  a  constitutional 
origin  of  cancer,  and  have  persisted  in  re- 
garding it  as  a  local  disease,  and  have  so 
long  trifled  with  it,  by  seeking  to  remove 
the  results  of  the  disease,  while  neglecting 
to  rectify  its  cause;  for  in  spite  of  active 
and  intelligent  surgery  the  death  rate  ad- 
vances with  sure  and  steady  steps. 

Prophylaxis  of  Cancer.  From  what  has 
preceded  it  can  readily  be  understood  that 
the  prevention  of  cancer  lies  largely  along 
dietary  and  hygienic  lines,  including  such 
medical  attention  as  shall  secure  healthy 
action  of  the  secreting  and  excreting  or- 
gans.   If  the  figures  and  facts  obtainable 


GENERAL  RELATIONS         107 

are  correct,  if  cancer  has  surely  been  ob- 
served to  increase  under  certain  conditions 
of  life,  if  it  is  found  to  be  absent  or  rela- 
tively rare  under  certain  other  conditions 
of  living,  if  cancer  has  been  known  to  dis- 
appear spontaneously  in  certain  individu- 
als, especially  when  they  have  changed 
their  mode  of  living,  it  must  then  follow 
that  when  the  exactly  correct  habit  and 
state  of  life  are  continually  maintained,  the 
disease  will  not  occur. 

In  other  words,  when  the  blood  stream 
nourishing  the  tissues  is  ideally  correct,  the 
individual  cells  of  the  body  perform  their 
functions  normally,  and  as  each  cell  is  worn 
out  it  is  removed  by  a  healthy  catabolism 
and  renewed  by  a  normal  anabolism,  and 
homologous  cells  replace  those  which  have 
ceased  to  be  able  to  perform  their  function. 
On  the  other  hand,  when  there  is  perverted 
metabolism  we  have  various  forms  of  de- 
ranged action,  to  which  we  give  the  names 
of  various  diseases,  one  of  which  is  cancer. 
Here  in  place  of  homologous  cells,  main- 


108  MEDICAL  ASPECTS  OF  CANCER 

taining  the  tissues  in  a  normal  condition, 
we  have  a  malignant  metamorphosis  into 
heterologous  cells,  which  take  on  a  disor- 
derly or  rampant  action,  and  refuse  to  as- 
similate themselves  to  others,  so  as  to  form 
healthy  tissue ;  we  have  then  a  mass  of  low 
vitality  tending  easily  to  break  down  and 
ulcerate,  and  to  extend  their  malignant  ac- 
tion to  adjoining  tissues,  under  the  contin- 
ued influence  of  a  contaminated  blood  cur- 
rent. 

Time  does  not  permit  further  elaboration 
of  this  important  subject,  the  details  of 
which  must  now  be  patent  to  all.  They  are 
included  in  a  simple  living,  with  perfect 
mastication,  reasonable  exercise,  the  avoid- 
ance of  all  excesses,  especially  along  the 
lines  of  protein,  tea  and  coffee,  alcohol,  etc., 
with  the  maintenance  of  healthy  habits  of 
life,  especially  in  regard  to  bowel  action. 
The  greatest  safety  is  with  an  absolute  veg- 
etarian diet,  with  the  single  exception  of 
butter. 

The  medical  treatment  of  cancer  can  be 


GENERAL  RELATIONS        109 

put  in  a  few  words,  although  iu  individual 
cases  it  may  involve  the  most  assiduous 
attention  to  the  most  minute  particulars  re- 
garding the  individual  in  many  directions, 
and  over  a  greatly  prolonged  period  of 
time;  no  detail  of  the  patient's  life  can  be 
too  small  or  insignificant  to  have  some 
bearing  on  the  deranged  metabolism  which 
affects  the  cancerous  growth,  for  good  or 
bad. 

There  is,  of  course,  no  single  remedy  for 
cancer,  nor  will  there  ever  be,  because  of 
the  true  nature  of  the  disease,  as  I  have 
tried  to  outline  it.  For  the  same  reasons  I 
caimot  believe  in  a  successful  serum  ther- 
apy, it  seems  so  illogical,  and  the  veiy  mul- 
tiplicity of  the  forms  of  serum  which  have 
been  lauded  from  time  to  time,  only  to  end 
in  disappointment,  would  seem  to  point 
toward  ultimate  failure,  when  all  possibili- 
ties along  this  line  have  been  exhausted. 

The  first  element  of  treatment  is  an  ab- 
solutely correct  vegetarian  diet,  with  avoid- 
ance of  coffee  and  alcohol  in  everv  form. 


110  MEDICAL  ASPECTS  OF  CANCER 

But  it  is  not  enough  for  the  physician  to 
simply  direct  that  this  be  taken,  but  to  be 
thoroughly  successful  every  detail  must  be 
carefully  attended  to  so  that  the  patient 
receives  adequate  nourishment.  The  de- 
tails of  this  cannot  be  dwelt  upon,  and  the 
matter  is  fully  considered  in  various  works 
on  food  and  nutrition.  A  vegetarian  diet 
needs  no  defense,  for  millions  of  human 
beings  naturally  live  thus,  and  escape  can- 
cer, and  thousands  in  civilized  lands  are 
adopting  it  for  health.  But  there  must 
always  be  care  taken,  not  only  that  suffi- 
cient calories  are  consumed  each  day,  but 
also  that  there  is  a  daily  proper  amount 
of  vegetable  protein,  carbohydrate,  and  fat 
in  a  form  and  condition  to  be  acceptable 
and  well  digested.  A  good  part  of  the  fat 
required  can  be  supplied  by  butter,  of 
which  one-quarter  of  a  pound  should  be 
taken  daily,  representing  800  calories. 

It  would  surprise  you  if  you  knew  how 
almost  invariably  cancer  patients  are  con- 
stipated and  have  long  been  so.     Indeed, 


GENEEAL  RELATIONS        111 

with  me  it  is  such  a  great  exception  to  find 
it  otherwise  that  I  have  come  to  look  upon 
this  feature  of  imperfect  intestinal  excre- 
tion, or  intestinal  stasis,  as  it  is  now  called, 
as  one  of  the  prime  elements  in  the  causa- 
tion of  cancer.  This  has  been  strongly  em- 
phasized by  Sir  Arbuthnot  Lane,  the  dis- 
tinguished English  surgeon,  who  has  spo- 
ken of  cancer  as  one  of  the  terminal  results 
of  intestinal  stasis.  I  feel  almost  like  say- 
ing that  the  toxins  produced  by  the 
millions  of  micro-organisms  generated 
through  intestinal  stasis  and  fecal  putre- 
faction are  the  real,  incidental  cause  of 
cancer. 

The  kidney  secretion  is  also  found  to  be 
at  fault  in  every  case  of  cancer  which  I 
have  studied,  and  is,  of  course,  an  indica- 
tion of  the  faulty  metabolism  which  pre- 
vails in  these  cases.  It  is  necessary,  there- 
fore, to  study  this  excretion  repeatedly  and 
most  carefully,  in  all  possible  directions,  in 
order  to  understand  the  exact  condition  of 
the  patient,  as  it  changes,  daily  or  weekly. 


112  MEDICAL  ASPECTS  OF  CANCER 

This  does  not  refer  to  the  presence  of  albu- 
men or  sugar,  for  I  have  seldom  found 
these  in  my  eases,  but  it  relates  to  the  total 
amount  of  solids  thus  excreted  daily,  and 
to  the  various  component  parts  and  their 
relation  to  one  another.  I  have  already 
mentioned  that  I  seldom  find  the  total 
amount  equal  to  that  which  should  be 
passed  in  proportion  to  the  body  weight  of 
the  patient,  although  often  the  quantity  of 
the  urine  may  not  be  far  from  normal. 

For  this  purpose  a  very  thorough  volu- 
metric analysis  should  be  made  weekly  of 
the  urine,  which  should  be  measured  and 
recorded  daily,  as  is  the  routine  in  the  hos- 
pital and  in  many  of  my  private  cases.  The 
measured  volumetric  acidity  is  verj  impor- 
tant, as  also  the  urea,  chlorides,  phos- 
phates, sulphates,  indican,  etc.,  and  the 
treatment  should  be  guided  thereby,  the 
aim  being  to  secure  a  return  to  metabolic 
health.  Alkalies  form  a  very  important 
part  of  the  treatment  of  these  cases,  but 
details  cannot  be  given  for  want  of  time. 


GENERAL  RELATIONS        113 

We  have  seen  that  the  blood  presents 
great  changes  in  cancer,  and  this  should  be 
studied  weekly,  and  iron  or  other  remedies 
given  as  indicated.  The  weight  of  the  pa- 
tient should  also  be  taken  weekly,  and 
while  it  is  often  desirable  to  reduce  those 
who  are  corpulent,  more  commonly  the 
weight  is  watched  to  improve  the  nutrition 
by  proper  dietary  or  medicinal  measures, 
which  cannot  be  here  dwelt  upon. 

If  time  permitted  I  wanted  to  give  you 
in  detail  reports  of  some  of  the  many 
cases  which  I  have  had,  mainly  in  private 
practice  during  the  last  thirty  and  more 
years,  for  it  is  hard  to  carry  out  satis- 
factory treatment  in  hospital  cases  for  a 
sufficient  length  of  time  to  be  sure  of  posi- 
tive results,  but  I  must  content  myself 
with  very  brief  mention  of  the  same. 

I  will  not  weary  you  with  statistics, 
but  only  state  that  I  have  a  hundred  or 
more  records  of  cases  in  my  office,  and  a 
considerable  number  in  the  New  York  Skin 
and  Cancer  Hospital,  where  I  have  taken 


114  MEDICAL  ASPECTS  OF  CANCER 

up  this  special  line  of  investigation  and 
treatment  during  the  past  year.  In  about 
one-quarter  of  the  cases  in  private  prac- 
tice, there  had  been  previous  surgical  re- 
moval, with  recurrence;  many  of  the  other 
cases  were  small,  early  tumors,  but  some 
of  them  quite  far  advanced  before  treat- 
ment, some  even  with  much  ulceration  and 
metastatic  adenopathy.  In  almost  all  of 
them  other  medical  men,  often  several,  had 
previously  diagnosed  cancer,  and  in  a 
number  of  instances  surgical  operations 
had  been  arranged  for.  So  that  while  the 
diagnosis  could  not  be  confirmed  micro- 
scopically in  a  large  share  of  cases,  there 
could  be  little  doubt  as  to  its  accuracy. 
And  even  if  possibly  some  few  of  the 
cases  were  only  simple  adenoma  of  the 
breast,  the  dissipation  of  this  by  non-sur- 
gical measures  avoided  an  operation  which 
might  possibly  be  followed  by  cancer,  as 
has  happened  in  certain  cases  which  had 
been  shown  microscopically  to  be  only  ad- 
enoma after  removal.    In  addition  to  the 


GENERAL  RELATIONS        115 

cancer  cases  there  were  also  some  22  other 
breast  tumors  which  were  not  included 
among  the  former.  I  will  briefly  mention 
a  few  of  the  cancer  cases: 

Case  I. — Mrs.  B.  E.  C,  aged  44,  was  first  seen 
on  September  12,  1892.  She  had  a  flat,  painful 
tumor  in  the  outer  lower  segment  of  the  right 
breast,  pronounced  cancer  by  a  well-known 
prominent  surgeon,  who  strongly  urged  its  in- 
stant removal.  AVithin  six  months  the  breast  be- 
came perfectly  normal,  and  remained  so  for  six- 
teen years,  when  I  lost  sight  of  her. 

Case  II. — Miss  B.  M.  L.,  aged  45,  was  first 
seen  January  4,  1894,  with  a  painful  tumor  in 
the  upper  outer  quadrant  of  the  left  breast,  diag- 
nosed as  cancer  by  three  medical  men,  one  of 
them  a  surgeon  of  prominence,  who  had  ar- 
ranged for  surgical  removal  the  next  day. 
Within  two  months  the  tumor  was  less  distinct 
and  flatter,  but  it  did  not  entirely  disappear  for 
eleven  months.  She  was  seen  from  time  to  time 
also  for  sixteen  years,  and  had  had  no  recur- 
rence, the  breasts  being  both  normal  when  exam- 
ined at  the  end  of  that  time. 

Case  III. — Miss  J.  M.  A.,  aged  45,  was  first 
seen  October  12,  1905,  ^vith  a  tumor  of  the  up- 
per, inner  quadrant  of  the  left  breast,  awaking 
her  with  pain  at  night,  which  had  been  repeat- 
edly diagnosed  as  cancer  by  different  medical 
men  and  surgeons,  the  latter  insisting  on  its  sur- 


116  MEDICAL  ASPECTS  OF  CANCER 

gical  removal ;  but  she  had  always  declined  oper- 
ation. Within  two  months  there  was  little  to  be 
felt  in  the  breast,  and  on  January  6,  1906,  three 
months  from  the  first,  it  had  quite  disappeared, 
both  breasts  being  perfectly  normal.  She  has 
been  seen  for  various  troubles,  up  to  the  present 
time,  over  nine  years,  and  remains  perfectly  free 
from  any  breast  trouble,  in  spite  of  hard  work 
and  worry  all  the  time,  as  a  city  missionary. 

Case  IV. — Miss  G.  M.,  aged  44,  has  been  un- 
der constant  surveillance  and  treatment  for  vari- 
ous troubles  since  she  was  first  seen,  November 
13,  1905,  up  to  the  present  time.  She  had  a 
tumor  in  the  upper,  inner  segment  of  the  left 
breast,  with  enlarged  axillary  glands;  several 
medical  men  had  diagnosed  it  cancer,  and  a  hos- 
pital surgeon  of  prominence  had  pressed  for  an 
immediate  operation.  Within  four  weeks  the 
painful  sensations  had  almost  passed  away,  and 
the  tumor  had  diminished  materially  in  size.  A 
month  later  the  breast  was  almost  the  same  as 
the  other,  with  some  general  caking  in  both. 
During  these  nine  years  she  has  been  bus}^  as  a 
public  school  teacher,  and  although  troubled 
with  rheumatism,  etc.,  there  has  never  been  any 
recurrence  of  the  tumor,  although  at  times  there 
is  caking  of  both  breasts  with  the  menstrual  pe- 
riod: the  axillary  adenopathy  has  long  ago  dis- 
appeared!. Her  sister,  aged  60,  has  just  died 
with  cancer  of  the  stomach  in  a  distant  locality. 
I  could  give  many  more  such  cases,  less  striking 
perhaps,  but  time  allows  only  of  brief  mention  of 
some  cases  which  had  recurred  after  operation. 


GENERAL  RELATIONS         117 

Case  V. — Miss  H.  M.,  aged  61,  came  to  me 
June  21,  1913,  with  multiple  nodules  in  the  tense 
skin  left  after  removal  of  cancer  in  August,  1911, 
further  surgical  operation  being  out  of  the  ques- 
tion. Under  very  active  treatment,  including 
thyroid  and  x-rays,  many  of  the  tumors  disap- 
peared, though  some  reformed  and  were  removed 
under  local  anesthesia,  the  wounds  healing 
kindly;  she  lived  comfortably,  under  frequent 
observation,  without  pain,  for  sixteen  months, 
and  then  was  lost  sight  of,  as  she  was  doing  very 
well  and  wanted  to  take  the  x-rays  nearer  her 
home,  some  distance  from  the  city. 

Case  VI. — Mrs.  W.  C,  aged  45,  first  seen  No- 
vember 17,  191-1,  was  twice  operated  on  at  the 
New  York  Skin  and  Cancer  Hospital,  and  came 
to  me  with  some  hard,  recurrent  lumps,  reddened 
and  immovable,  quite  inoperable.  Under  faith- 
ful treatment  she  has  been  very  well,  without 
pain,  and  doing  hard  work  at  house  cleaning, 
etc.  She  is  yet  under  treatment,  and  lately  a 
new  lump  has  formed,  though  the  others  have 
subsided  materially :  but  she  experienced  no  pain 
and  during  these  five  months  has  worked  very 
hard,  without  much  or  any  concern  regarding 
her  trouble,  except  to  follow  out  treatment 
faithfully. 

One  case  treated  in  tlie  hospital,  with 
very  careful  laboratory  studies,  is  worthy 
of  mention,  on  account  of  the  remarkable 


118  MEDICAL  ASPECTS  OF  CANCER 

improvement  occurring  in  an  apparently 
hopeless  case. 

Case  VII. — Mrs.  C.  M.  was  first  seen  Feb- 
ruary 12,  1914,  with  cancer  of  the  right  breast, 
which  had  been  operated  on  twice,  on  Novem- 
ber 14,  1912,  and  January  16,  1914.  "When  seen 
there  was  ulceration  with  many  nodules  around, 
the  liver  was  enlarged  to  two  inches  below  the 
ribs,  hard  and  nodular;  the  right  arm  was  enor- 
mously swollen  and  helpless.  When  she  left  the 
hospital,  against  my  wishes,  June  20,  1914,  in 
four  months,  the  ulceration  had  entirely  healed, 
many  of  the  nodules  had  entirely  disappeared, 
and  the  arm  had  returned  to  normal  size,  like 
the  other,  by  measurement,  and  the  liver  had  re- 
tracted to  a  trifle  below  the  margin  of  the  ribs, 
with  hardly  any  nodules  to  be  felt.  While  in  the 
hospital  careful  laboratory  investigations  were 
made  according  to  a  definite  daily  and  weekly 
schedule,  which  cannot  be  detailed  here.  Suffice 
to  say,  the  blood  improved  from  3,262,000  ery- 
throcytes on  entering,  within  two  months  to 
4,282',000,  and  the  leucocytes  fell  from  9,000  to 
5,200  with  many  other  improvements  in  her  con- 
dition. 

I  must  just  mention  one  more  private 
case,  which  though  fatal  showed  the  re- 
markably good  effects  of  careful  medical 
treatment,  when  a  primary  case  has  ad- 


GENERAL  RELATIONS        119 

vanced  far  beyond  the  possible  aid  of  sur- 
gery: 

Case  VIII.— Mrs.  M.  B.  J.,  aged  68,  was  first 
seen  February  17,  1914,  with  an  enormous  hard, 
cancerous  mass  in  the  right  breast,  the  size  of 
half  a  large  melon,  ulcerated  under  a  crust  over 
much  of  the  surface,  and  with  immense  axillary 
and  supraclavicular  adenopathy.  This  had  been 
kept  concealed  until  the  day  before  she  called, 
and  she  was  profoundly  cachectic.  In  a  short 
time  the  discharge  beneath  the  crust  ceased,  the 
breast  became  softer,  and  on  August  15,  it  was 
recorded  that  it  was  soft  and  movable,  and  not 
larger  than  the  other  breast,  with  no  discharge, 
and  no  pain  since  a  short  time  after  beginning 
treatment;  the  axillary  glands  had  diminished 
three-quarters  in  size,  and  the  supraclavicular 
glands  were  much  smaller.  She  died  with  pul- 
monary edema  on  September  9th,  having  had 
practically  no  inconvenience  from  the  breast 
during  the  seven  months  of  treatment. 

Our  time  does  not  permit  any  further 
consideration  of  this  most  interesting  and 
important  subject,  and  I  fear  that  I  have 
trespassed  already  too  greatly  on  your 
patience.  But  feeling  as  I  have  for  many 
years,  with  a  constantly  growing  confi- 
dence in  my  thesis  in  regard  to  the  cause 


120  MEDICAL  ASPECTS  OF  CANCER 

of  cancer  and  its  proper  treatment,  and 
with  increasing  experience,  I  cannot  do 
otherwise  than  urge  all  whom  I  may,  to 
investigate,  and  see  if  the  claims  I  make 
are  correct.  I  know  well  that  I  am  going 
contrary  to  the  commonly  accepted  ideas 
in  regard  to  cancer,  and  that  very  much 
work  will  be  necessary  before  the  views 
here  presented  mil  be  adopted  and  acted 
upon  sufficiently  to  check  the  steadily  ris- 
ing mortality  from  this  terrible  disease. 
But  if  the  facts  and  statistics  which  I 
have  referred  to  are  found  to  be  correct 
by  others,  it  is  not  too  much  to  hope  that, 
within  the  next  generation  at  least,  the 
mortality  table  will  show  a  decline  more 
or  less  commensurate  with  that  which  has 
taken  place  in  regard  to  tuberculosis  and 
pneumonia,  and  we  will  no  longer  have  the 
frightful  death  rate  of  90  per  cent,  of 
cancer  victims. 


CHAPTER  VII 

THE    RELATION    OF    DIET    TO     CANCER* 

That  deaths  from  cancer  are  certainly 
on  the  steady  increase  in  this  and  other 
countries  has  been  abundantly  shown  by 
statistics,  which  need  not  be  quoted  here. 
That  the  evident  increase  of  cancer  is  not 
wholly  or  even  largely  due  to  more  ac- 
curate diagnosis  and  public  attention  to 
the  disease  is  admitted  by  all  who  have 
given  due  consideration  to  the  subject; 
that  thus  far  practically  nothing  has  been 
accomplished  in  the  way  of  checking  the 
extension  of  cancer  is  also  a  matter  of 
general  knowledge;  and  all  this  in  spite 
of  the  earnest  and  faithful  work  of  innu- 
merable research  workers,  and  the  expen- 
diture of  vast  sums  of  money. 


*  Read  before  the  Section  on  Pathology  and  Physi- 
ology, American  Medical  Association.  June  25,  1914. 

121 


122  MEDICAL  ASPECTS  OF  CANCER 

It  is  proposed  here  to  make  a  brief  re- 
view of  the  present  position  of  the  ques- 
tion involved,  to  examine  some  of  the  facts 
concerning  malignant  disease,  and  to  in- 
quire if  sufficient  attention  has  been  paid 
to  a  certain  element  which  so  largely  con- 
cerns the  health  and  well-being  of  the  in- 
dividual, and  the  structure  and  growth  of 
normal  and  abnormal  tissues,  namely,  diet. 

There  must,  of  course,  be  some  reason 
for  the  increase  of  cancer,  and  earnest 
work  should  still  be  given  to  searching 
most  diligently  for  the  cause  of  the  dis- 
ease, in  the  laboratory  as  well  as  in  prac- 
tice, even  though  as  yet  there  have  been 
relatively  little  results. 

Parasitism  has  been  excluded,  for  while 
in  some  animals  inoculation  experiments 
have  resulted  in  the  transmission  of  cer- 
tain tumors,  little  has  been  determined  ex- 
cept that  the  tumor  cell  when  transplanted 
can  induce  the  neighboring  tissue  cells  to 
take  on  a  similar  aberrant  action,  which 
may  result  in  the  formation  of  a  malig- 


DIET  AND  CANCER  123 

nant  tumor.  The  same  occurs  in  metasta- 
sis in  cancer  patients.  But  this  does  not 
at  all  explain  the  true  nature  of  cancer, 
nor  its  development  in  those  who  have  had 
no  connection  with  other  patients  so  af- 
flicted. On  the  other  hand,  the  instances 
of  suggested  or  supposed  human  trans- 
mission of  cancer  from  one  person  to  an- 
other are  so  remarkably  few,  and  often 
so  exceedingly  doubtful,  that  the  question 
of  its  contagiousness  has  also  been  ex- 
cluded, certainly  in  the  sense  in  which  this 
term  is  applied  to  other  affections.  It 
has  been  found  impossible  to  inoculate  hu- 
man cancer  into  rats,  mice,  and  apes,  or 
to  inoculate  animal  tumors  into  animals  of 
different  species. 

Heredity  has  been  advanced  as  a  cause, 
but  statistics  fail  to  verify  this  in  any 
degree  whatever.  In  former  years  malaria 
was  believed  to  have  an  influence,  and  one 
investigator  thought  to  trace  the  preva- 
lence of  cancer  to  telluric  influence,  show- 
ing a  preponderance  of  cases  along  cer- 


124  MEDICAL  ASPECTS  OF  CANCER 

tain  water  courses;  syphilis,  in  its  latent 
effects,  lias  also  been  claimed  as  an  ele- 
ment in  the  causation  of  cancer;  but  all 
these  and  many  other  etiological  proposi- 
tions are  no  longer  considered  to  be  tena- 
ble, and  the  very  multiplicity  of  suggested 
causes  shows  that  we  are  yet  far  from  the 
true  etiology  of  cancer. 

More  recent  scientific  study  has  attempt- 
ed to  show  that  cancer  originates  from 
what  is  called  ''embryonic  rests,"  or  pre- 
natal, wrongly  placed  tissue  elements, 
which  at  some  time  or  other  take  on  mor- 
bid action  and  develop  into  what  we  know 
as  the  various  forms  of  cancer.  But  here 
again  it  is  necessary  to  determine  what 
causes  them  at  certain  times  and  in  cer- 
tain places  thus  to  proliferate  and  form 
new  tissue,  which  then  becomes  malignant 
and  may  proceed  to  destroy  all  contigu- 
ous tissues,  and  even  to  cause  death.  It 
has  been  claimed  by  many  that  local  in- 
jury is  the  cause  which  determines  the  ac- 
tivity of  the  misplaced  cells,  and  starts 


DIET  AND  CANCER  125 

them  on  their  disastrous  or  rampant 
course.  While  this  appears  to  be  the  case 
in  certain  instances,  it  is  far  from  proven 
to  be  always  so,  nor  does  it  in  any  way 
explain  the  persistency  with  which  malig- 
nant disease,  when  once  started,  pursues 
its  destructive  and  even  fatal  career,  with 
a  great  tendency  to  recurrence,  either  in 
the  former  site  or  at  some  distant  focus, 
through  the  agency  of  the  lymphatic  or 
vascular  system. 

On  the  basis  of  the  embryonic  theory 
surgeons  have  of  late  most  earnestly  ad- 
vocated the  very  early  and  complete  re- 
moval of  malignant  lesions,  including 
those  of  suspected  malignancy,  and  even 
many  innocent  lesions  which  are  observed 
occasionally  to  lead  to  cancerous  forma- 
tion ;  and  with  our  present  knowledge  this 
cannot  be  urged  too  strongly.  But  while 
this  has  improved  operative  statistics  it 
has  not  contributed  much  to  our  real 
knowledge  of  the  basic  cause  of  cancer, 
nor  has  it  taught  us  why  these  lesions,  or 


126  MEDICAL  ASPECTS  OF  CANCER 

'* embryonic  rests,''  will  remain  quiescent 
or  prove  harmless  in  some  individuals, 
while  in  others  they  are  most  formidable 
agents  of  destruction.  For  it  is  now  rec- 
ognized that  these  are  most  common  ana- 
tomical or  histological  accidents,  indeed 
it  is  claimed  that  they  occur  in  every  in- 
dividual. 

The  same  is  true  of  the  many  and  vari- 
ous forms  of  treatment  other  than  sur- 
gical excision,  such  as  deep  acting  caustics, 
and  even  the  rr-ray  and  radium,  which, 
like  surgery,  only  remove  the  products  of 
disease  and  the  focus  of  possible  systemic 
infection,  and  do  not  affect  the  basic  cause 
of  the  complaint;  this  latter  recent  scien- 
tific investigation  and  observation  are 
showing  more  and  more  to  be  associated 
with  metabolic  or  chemico-physiological 
changes  in  the  system.  All  this  leads 
thoughtful  persons  to  inquire  if  there  is 
not  some  deeper,  fundamental  cause  lying 
back  of  the  trouble,  which  should  be 
reached  and  rectified  by  medical  skill. 


DIET  AND  CANCER  127 

It  is  recognized  by  all  that  the  tissues 
develop  and  are  maintained  by  nutrition 
derived  from  the  food  and  drink  taken, 
and  tumors  all  certainly  grow  by  the  same 
means.  For  years  it  has  been  claimed  by 
one  person  after  another  that  diet  has 
more  or  less  influence  in  the  production 
of  cancer,  and  even  over  one  hundred 
years  ago  Howard  Lambe  and  others  ad- 
duced strong  proof  to  show  the  effect  of 
diet  in  curing  certain  cases  of  undoubted 
cancer  of  the  breast  and  uterus,  the  diag- 
nosis of  which  was  confirmed  by  promi- 
nent surgeons  of  the  day. 

It  has  been  pretty  clearly  demonstrated 
that  cancer  is  a  disease  of  civilization,  in- 
creasing among  those  peoples  who  had 
previously  been  free  from  it,  in  propor- 
tion as  they  become  associated  with  those 
who  are  more  highly  civilized,  and  as  they 
have  adopted  their  customs  and  manner 
of  life,  and  diet;  this  has  been  shown  in 
regard  to  negroes  before  and  after  the 
Civil  War,  and  also  as  to  primitive  peo- 


128  MEDICAL  ASPECTS  OF  CANCER 

pie  in  India,  Australia,  Africa,  Mexico, 
Brazil,  etc. 

With  advancing  civilization  the  diet  has 
become  more  and  more  complicated,  and 
luxury  and  overeating  have  increased: 
this  is  especially  true  of  meat  eating,  and 
alcohol  and  coffee  drinking.  The  increase 
in  the  consumption  of  meat  has  been  start- 
ling in  many  localities,  and  in  England  it 
has  reached  a  yearly  total  of  130  pounds 
per  capita  for  men,  women  and  children, 
in  addition  to  large  quantities  of  fish, 
game,  poultry,  rabbits,  eggs,  cheese,  etc. 
Among  the  well-to-do  the  meat  consump- 
tion has  been  estimated  at  between  180 
and  330  pounds  per  year:  all  this  is 
much  more  than  double  the  amount  con- 
sumed fifty  years  ago,  and  in  the  same 
time  the  deaths  from  cancer  have  in- 
creased over  four  fold. 

The  same  figures  apply  roughly  to  the 
United  States,  where  the  per  capita  meat 
consumption  is  said  to  be  considerably  in 
excess  of  the  European  average,  and  all 


DIET  AND  CANCER  129 

statistics  show  that  cancer  is  rapidly  in- 
creasing in  this  country.  In  a  recent  Bul- 
letin of  the  Board  of  Health  of  New 
York  City  the  following  statements  are 
made  in  regard  to  the  mortality  from  can- 
cer in  1913 :  *  *  The  statistics  of  our  seven 
largest  cities  recently  tabulated,  show  that 
in  that  year  the  cancer  death  rate  was  the 
highest  on  record.  For  New  York  City 
the  rate  was  82  per  100,000  of  the  popula- 
tion, against  an  average  of  79  for  the  last 
five  years;  for  Boston  118,  against  an 
average  of  110 ;  for  Pittsburgh  79,  against 
an  average  of  70;  for  Baltimore  105, 
against  an  average  of  94;  for  Chicago  86, 
against  an  average  of  81;  for  Philadel- 
phia 95,  against  an  average  of  88;  for  St. 
Louis  95,  against  an  average  of  85.'* 
This  average  increase  of  over  8  per  cent, 
of  deaths  from  cancer  in  the  combined 
population  of  these  seven  cities  during  the 
last  five  years  is  certainly  an  alarming 
fact,  and  cannot  be  explained  on  the 
ground  of  greater  accuracy  of  diagnosis; 


130  MEDICAL  ASPECTS  OF  CANCER 

for  it  is  not  to  be  presumed  that  there  has 
been  such  great  improvement  along  these 
lines  during  the  single  year  1913.  It  has 
been  shown  that  with  the  same  rate  of  in- 
crease of  deaths  from  cancer,  unless  there 
be  found  some  way  to  check  its  produc- 
tion, the  death  rate  at  the  end  of  the  cen- 
tury will  be  appalling. 

In  striking  contrast  to  the  enormous 
extent  and  increase  of  cancer  in  meat- 
eating  communities  may  be  mentioned  the 
relative  rarity  or  almost  absence  of  the 
disease  in  regions  where  the  diet  is  largely 
confined  to  the  products  of  the  ground. 
Williams*  has  collected  from  all  sources 
the  greatest  amount  of  evidence  that  can- 
cer is  relatively  rare,  and  often  really  un- 
known, as  reported  by  competent  observ- 
ers, among  various  aborigines  in  the  in- 
terior of  many  countries,  who  live  on  the 
products  of  the  vegetable  kingdom,  with 
little  if  any  meat  secured  in  hunting. 

Is  it  not  possible  and  even  probable  that 
the  relatively  less  increase  in  cancer  in 


DIET  AND  CANCER  131 

New  York  City  during  tlie  last  five  years 
is  in  part  due  to  dietary  causes?  Thus 
in  1913  the  death  rate  was  82  per  100,000, 
against  79  for  the  average  of  the  preced- 
ing five  years,  while  the  highest  increase 
was  in  Baltimore,  105  against  94,  or  11  per 
100,000  to  3  in  New  York  City.  It  is 
known  that  we  here,  in  New  York  City, 
have  vast  hordes  of  foreigners,  many  new- 
ly landed,  who  still  live  as  at  home,  and 
are  too  poor  to  huy  much  meat.  The  Ital- 
ians still  live  on  macaroni,  and  cereals 
form  a  large  part  of  the  diet  of  those  from 
southern  Europe,  etc.,  etc.  During  a  rather 
extensive  trip  through  the  Far  East  I 
was  unable  to  see  or  even  hear  of  any 
cancer,  although  I  met  a  large  number  of 
medical  men  and  made  inquiry  regarding 
the  same,  and  visited  hospitals  with  a  to- 
tal of  many  thousands  of  patients;  in 
Japan,  Korea,  China,  the  Phillippines,  In- 
dia, Siam,  and  Egypt  I  met  the  same  re- 
sponse, that  cancer  was  rarely  seen  among 
those  vegetarian  peoples. 


132  MEDICAL  ASPECTS  OF  CANCER 

Cancer  has  repeatedly  been  observed  to 
disappear  spontaneously,  and  many  such 
cases  are  on  record  by  careful  and  com- 
petent medical  men:  in  certain  of  these 
instances  it  has  occurred  in  connection 
with  a  radical  change  in  the  mode  of  life 
and  diet,  but  in  the  majority  of  instances 
there  is  no  record  of  the  special  cause 
of  its  disappearance.  But  the  lesson  to  be 
learned  from  this  is  that  there  are  condi- 
tions of  the  system  which  are  antagonistic 
to  the  abnormal  proliferation  of  cell  tis- 
sue, even  when  it  has  begun  to  take  place, 
as  we  must  believe  that  there  are  condi- 
tions of  the  system  which  favor  such  dis- 
eased action  of  aberrant  cells.  An  inter- 
esting confirmation  of  this  is  attributed  to 
Ehrlich,  but  I  cannot  find  the  original  ref- 
erence. He  *^has  shown  that  mice  living 
upon  a  rice  diet  cannot  be  inoculated  with 
cancer,  while  mice  living  on  a  meat  diet 
can  be  readily  inoculated,  Cancerous  tu- 
mors developing  quickly  and  continuing  to 
grow  until  the  animal  dies.     Ehrlich  also 


DIET  AND  CANCER  133 

found  that  when  mice  with  cancerous  tu- 
mors, the  result  of  inoculation,  were 
placed  upon  a  rice  diet,  the  tumors  ceased 
to  grow  and  in  many  cases  degenerated 
and  disappeared/'  Interesting  confirma- 
tion of  this  has  been  given  by  Sweet,  Cor- 
son, White,  and  Saxon".  They  found  that 
75  per  cent,  of  75  mice  developed  experi- 
mentally inoculated  tumors  when  under 
normal  diet,  while  only  19  per  cent,  of  75 
other  mice  developed  such  tumors  when 
under  a  diet  of  glutenin  and  gliadin,  that 
is  vegetable  proteins ;  also  that  the  tumors 
in  the  latter  were  in  thirty  days  hardly 
larger  than  in  the  former  in  ten  days. 

Psoriasis  furnishes  an  illustration  which 
may  be  of  service  in  understanding  the  re- 
lation of  diet  to  cancer;  for  psoriasis  is 
characterized  by  a  disordered  epithelial 
growth,  which  both  shows  on  the  surface 
and  manifests  itself  by  epithelial  prolon- 
gations into  the  corium,  which  are  quite 
comparable  to  the  ingrowing  cellular 
masses  of  early  cancer;  moreover  it  is  not 


134  MEDICAL  ASPECTS  OF  CANCER 

so  very  rare  to  have  epithelioma  develop 
from  lesions  of  psoriasis. 

The  real  cause  of  psoriasis  has  not  as 
yet  been  established,  but  there  is  abundant 
testimony  to  show  that  the  eruption  is  in- 
timately connected  with  faulty  nitrogenous 
metabolism,  or  rather  with  the  presence 
of  an  excess  of  nitrogenous  matter  in  the 
system.  For  many  years  the  present 
writer  has  adduced  proof  of  this  rela- 
tionship, and  has  reported  a  number  of 
cases,  confirmed  by  other  practitioners, 
where  the  lesions  of  psoriasis  have  entire- 
ly disappeared,  simply  under  an  abso- 
lutely strict  vegetarian  diet,  excluding  also 
coffee  and  alcohol,  without  the  use  of  any 
medical  treatment  whatever,  internal  or 
external;  he  has  also  many  patients  in 
private  practice  who  remain  free  from 
eruption  while  strictly  faithful  to  the  same 
diet,  and  many  others  who  relapse  again 
and  again  when  the  diet  is  relaxed,  and 
again  lose  the  eruption  under  rigid  vege- 
tarian diet.     All  this  has  been  confirmed 


DIET  AND  CANCER  135 

by  other  observers,  and  very  strikingly  so 
by  Dr.  Schamberg',  who  made  some  very 
careful  laboratory  observations  in  connec- 
tion with  the  Philadelphia  Polyclinic,  on 
nine  psoriasic  patients.  From  his  studies 
he  concluded  that  these  patients  possess 
a  strong  tendency  to  store  nitrogen,  and 
that  on  a  high  protein  diet  tremendous 
quantities  of  nitrogen  may  be  retained  in 
the  system;  he  also  confirmed  the  injuri- 
ous effects  of  a  strong  nitrogenous  diet, 
and  the  disappearance  of  the  eruption 
under  vegetarian  diet.  We  are  as  yet 
quite  in  the  dark  as  to  why  various  dis- 
turbances in  regard  to  nitrogenous  and 
other  metabolism  take  place  in  the  body 
of  these  patients,  as  we  are  of  the  reasons 
of  gouty  and  diabetic  disorders,  but  clin- 
ical facts  often  lead  the  way  to  patho- 
logical discoveries,  and  those  in  regard  to 
psoriasis  are  instructive  and  suggestive 
in  our  present  study;  and  such  researches 
are  much  needed  in  regard  to  the  metabo- 
lism of  cancer  patients  before  the  develop- 


i 

136  MEDICAL  ASPECTS  OF  CANCER 

ment  of  the  disease,  or  in  its  early  stages 
although  considerable  work  has  already 
been  done  in  connection  with  the  chemico- 
pathology  of  advanced  cancer. 

There  is  an  analogy  to  be  found  between 
what  has  been  previously  mentioned  in 
connection  with  the  natural  history  of  can- 
cer, as  to  its  increase  in  connection  with 
the  greater  consumption  of  meat,  and  what 
has  just  been  detailed  in  regard  to  psori- 
asis. While  to  a  superficial  observer  there 
may  not  seem  to  be  any  very  great  connec- 
tion between  the  two  diseases,  there  is  in 
reality  a  lesson  to  be  learned  from  the  one 
to  the  other.  In  both  we  have  perverted 
and  active  proliferation  of  epithelial  cells, 
and  inasmuch  as  cell  growth  depends  up- 
on protein,  we  have  with  an  excessive 
nitrogenous  intake,  or  a  retention  of 
nitrogenous  elements,  an  augmentation  of 
the  eruption  of  psoriasis,  even  as  we  have 
seen  cancer  increase  with  the  increased 
consumption  of  meat.  And,  just  as  psori- 
asis has  been  observed  by  many  to  dis- 


4 


DIET  AND  CANCEE         ^37 

appear  when  the  nitrogenous  supply  was 
cut  oif,  so  numerous  observers  and  the 
present  writer  among  them,  have  seen  un- 
questioned cancer  steadily  retrogress  and 
even  disappear,  and  remain  absent,  under 
a  strictly  non-nitrogenous  diet. 

For  very  many  years  I  have  held  the 
view  that  meat  eating  was  productive  of 
cancer  and  have  treated  very  many  cases, 
of  both  recurrent  and  primary  cancer,  with 
an  absolutely  vegetarian  diet,  with  results 
in  some  cases  which  were  remarkable  and 
most  gratifying.  But  I  have  hesitated 
writing  strongly  on  the  subject  before  lest 
I  should  be  misunderstood  or  misjudged, 
as  in  such  cases  reliance  has  to  be  placed 
on  a  clinical  diagnosis  (always  verified  by 
others),  while  results  claimed  are  always 
open  to  question  by  some.  I  have  also 
feared  lest  I  might  really  do  harm  by  ad- 
vocating a  medical  consideration  and  treat- 
ment of  cancer,  since  thereby  some  might 
be  led  to  neglect  operative  measures  in 
proper  cases,  at  the  proper  time;  and  so 


138  MEDICAL  ASPECTS  OF  CANCER 

in  certain  instances  great  injury  and  in- 
justice might  be  done  to  the  patient,  and 
the  time  pass  in  which  a  surgical  operation 
might  possibly  be  of  service. 

I  wish,  therefore,  to  repeat  what  I  said 
before,  that  with  our  present  knowledge 
competent  surgical  interference  cannot  be 
urged  too  early  or  too  strongly  in  suitable 
cases ;  but  I  wish  also  to  enter  my  strong 
protest  against  the  course  which  is  usually 
followed  in  regard  to  cancer,  both  before 
and  after  operation.  With  a  rather  ex- 
tended experience,  during  the  last  forty 
years  I  have  almost  yet  to  find  a  case  which 
has  received  adequate  and  continuous 
medical  care  before  operation,  with  a  view 
of  discovering  and  rectifying  the  cause  of 
the  morbid  growth.  Too  often  when  a  can- 
cer is  suspected  or  discovered  it  is  taken 
as  a  foregone  conclusion  that  the  malady 
is  hopeless,  except  as  the  results  of  the 
disease,  that  is  the  new  growth,  may  be  re- 
moved by  the  knife,  rr-ray,  radium,  caus- 
tics, etc.    And  after  a  surgical  operation, 


DIET  AND  CANCEK  139 

as  far  as  my  observation  goes,  the  patients 
are  invariably  left  entirely  to  their  own  re- 
sources, with  the  hope  that  the  tumor  will 
not  regrow,  but  with  no  attempt  so  to 
guide  the  life  that  there  shall  not  be  the 
tendency  to  a  recurrent  malignant  new 
formation. 

The  limits  of  the  present  paper  will  not 
admit  of  a  full  discussion  of  the  problems 
of  metabolism  and  chemico-pathology 
which  may  and  often  have  to  do  with  this 
tendency  to  misgrowth  of  tissue,  concern- 
ing which  there  have  been  some  interesting 
and  valuable  researches  which  are  of 
practical  importance  in  regard  to  the  pre- 
vention of  cancer,  but  brief  mention  may 
be  made  of  a  few  points. 

Ross^  has  satisfied  himself  that  there  is  a 
failure  in  the  potash  element  in  patients 
who  are  subject  to  cancer,  and  for  many 
years  he  has  administered  one  of  the  salts 
of  this  mineral  in  large  quantities,  both  to 
those  threatened  with  the  disease  and  even 
in  advanced  cases,  with  most  satisfactory 


140  MEDICAL  ASPECTS  OF  CANCER 

results.  This  I  can  verify  fully,  and  for 
very  many  years  I  have  given  the  acetate 
of  potassium  to  a  large  number  of  patients 
thus  afflicted,  and  am  confident  that  it  has 
had  a  large  share  in  producing  the  bene- 
fit that  has  been  observed.  Ross  calls  at- 
tention to  the  errors  which  existed  in  re- 
gard to  the  cooking  of  vegetables,  whereby 
the  natural  salts  are  extracted  in  the  wa- 
ter in  which  they  are  cooked,  which  is  then 
thrown  away;  among  the  aboriginal  na- 
tives who  are  vegetarians,  who  escape  the 
disease,  it  is  stated  that  they  consume  also 
the  water  in  which  vegetable  substances 
are  cooked.  This  waste  of  the  natural 
salts  is  especially  seen  in  connection  with 
the  cooking  of  potatoes.  These  are  com- 
monly peeled  before  being  boiled,  and  by 
this  means  the  inner  skin,  rich  in  salts,  is 
necessarily  removed,  and  the  exposed 
starchy  matter  is  then  further  devitalized 
by  the  water  in  which  they  are  boiled ;  they 
should  be  boiled  in  their  skins,  and  it  is 
even  better  to  eat  the  skins  as  well,  al- 


DIET  AND  CANCER  141 

though  their  outer  coating  may  then  be 
easily  stripped  off,  leaving  the  inner  skin, 
containing  abundance  of  potash  and  other 
salts.  Ross  adduces  much  proof  in  regard 
to  the  error  in  equilibrium  in  regard  to 
potash  salts  in  those  tending  to  cancer, 
which  cannot  be  detailed  here,  but  is 
worthy  of  serious  consideration. 

Time  fails  even  to  allude  to  the  various 
studies  which  have  been  made  in  regard  to 
the  many  alterations  in  metabolism  which 
have  been  observed  in  cancer  patients,  all 
however  showing  that  there  is  a  basic 
cause  for  the  remarkable  and  virulent  ac- 
tion which  certain  cells  of  the  body  may 
take  on  and  continue,  exciting  the  same 
diseased  condition  in  contiguous  cells,  be- 
cause they  also  are  bathed  in  the  same 
deranged  blood  stream. 

Why  in  some  individuals  a  disturbed 
nitrogenous  equilibrium  resulting  in  can- 
cer occurs,  while  so  many  escape,  remains 
still  an  unanswered  question,  like  so  many 
problems  in  medicine.    Chemico-physiology 


142  MEDICAL  ASPECTS  OF  CANCER 

and  pathology  are  yet  in  their  infancy, 
and  the  mysteries  of  anabolism  and  catab- 
olism  are  great,  but  that  they  and  the 
action  of  all  the  cells  composing  the  or- 
ganism are  under  the  influence  of  diet  is 
beyond  question.  It  is  also  certain  that 
various  other  causes,  such  as  mental  and 
physical  overstrain,  etc.,  can  produce  such  a 
derangement  of  the  vital  organs  of  the  body 
that  disturbed  metabolism  follows,  and 
that  a  diet  which  at  one  time  or  in  one  in- 
dividual is  well  borne,  at  another  time  or  in 
another  individual  produces  disease.  Accu- 
mulated evidence,  dating  back  many,  many 
years,  points  to  excessive  nitrogenous  in- 
take, together  with  faulty  cooking,  incident 
to  a  more  refined  civilization,  so-called,  as  a 
prolific  cause  for  the  development  of  can- 
cer, while  an  absolutely  vegetarian  diet, 
with  the  exclusion  of  coffee  and  alcohol,  in 
conjunction  with  proper  medicinal  meas- 
ures, has  repeatedly  resulted  in  the  dis- 
appearance of  cancer.  The  length  of  this 
paper  prevents  the  presentation  of  illustra- 


DIET  AND  CANCER  143 

tive  cases  which  have  occurred  in  my  prac- 
tice during  the  last  forty  years,  some  of 
the  subjects  remaining  entirely  well  for  ten 
or  more  years  thereafter. 

The  medical  treatment  of  these  cases 
along  lines  of  eliminative  and  constructive 
therapy,  undoubtedly  contributed  toward 
the  favorable  results,  but  unaided  by  diet- 
ary measures  these  would  certainly  have 
been  entirely  ineffective. 

KEFBRENCES 

1.  Williams:  ''The  Natural  History  of  Can- 
cer,'^  New  York,  1908. 

2.  Proceed.  Soc.  for  Exper.  Biol,  and  Med., 
New  York,  Vol.  X,  p.  175. 

3.  Schamberg:  Jour.  Cutan.  Dis.,  including 
Syphilis,  New  York,  October  and  November, 
1913. 

4.  Ross:  "Cancer,  the  Problem  of  Its  Genesis 
and  Treatment,"  London,  1912. 


CHAPTER  Vin 


DIETETIC       AND       MEDICAL       TREATMENT       OF 
CANCER* 


In  some  of  the  reviews  of  my  book  on 
** Cancer,  Its  Cause  and  Treatment/'  the 
regret  has  been  expressed  that  I  had  not 
given  more  exact  details  in  regard  to  the 
treatment  employed  in  obtaining  the  favor- 
able results  in  the  cases  reported.  This 
brevity  was  necessitated  in  part  by  the 
length  and  character  of  the  lectures,  which 
aimed  rather  at  demonstrating  the  meta- 
bolic nature  of  the  disease,  for  further 
study  and  proof;  and  in  part  by  the  diffi- 
culty of  being  more  definite,  within  the 
compass  of  the  lectures,  concerning  the 
many  and  various  measures  necessary  to 


♦  Read  before  the  Luzerne  County   (Pennsylvania) 
Medical  Society,  March  3,  1917. 

144 


DIETETIC   TREATMENT       145 

restore  perfect  metabolism,  and  so  alter 
the  system  to  an  anti-cancerous  state,  for 
each  cancer  case  requires  very  special 
study  and  often  most  varied  treatment.  It 
was  also  supposed  that  the  practicing  phy- 
sicians attending  the  lectures  would  be  able 
to  apply  the  principles  enunciated. 

It  must  be  understood  that  there  has  not 
yet  been  demonstrated  any  one  definite 
state  or  condition  of  the  system  which  cer- 
tainly leads  to  cancer,  and  perhaps  there 
may  never  be.  But  all  observation,  as  well 
as  statistical  evidence,  and  some  laboratory 
studies,  point  so  strongly  to  cancer  as  a 
disease  of  advancing  civilization,  and 
scientific  research  has  so  clearly  eliminated 
the  many  suggested  causes  of  malignant 
disease,  that  we  are  forced  by  exclusion  to 
look  to  metabolic  changes  in  the  system  as 
its  cause.  These,  leading  to  a  disordered 
blood  stream,  favor  the  disordered  growth 
of  certain  body  cells,  culminating  in  masses 
to  which  we  give  the  name  of  cancer.  For 
no  one  questions  that  nutrition,  good  or 


146  MEDICAL  ASPECTS  OF  CANCER 

bad,  depends  on  the  character  of  the  blood 
furnished  to  the  body  cells. 

In  many  reviews,  and  in  notices  of  a 
former  article,  I  have  been  quoted  as  re- 
garding meat  eating  as  the  cause  of  can- 
cer. This  is  only  partially  correct;  al- 
though I  have  shown  that  the  incidence  of 
cancer  is  closely  related  to  an  increase  in 
the  consumption  of  meat  in  many  locali- 
ties, and  have  pointed  out  its  relative  in- 
frequency  in  herbivorous  animals  and 
vegetarians.  But  the  very  fact  that  it  may 
occur  even  among  them  proves  that  there 
is  some  other  causative  element  not  yet 
fully  determined.  I  have  also  referred  to 
high  authorities  who  have  satisfactorily 
demonstrated  a  metabolic  disturbance  of 
protein  elements  in  cancer  subjects,  and  an 
imperfect  nitrogenous  partition  in  the 
urine.  Much  more  study  will  be  necessary, 
both  of  the  blood,  including  its  plasma,  and 
the  various  secretions  and  excretions,  both 
in  the  very  early  stage  of  cancer  and  also 
after  surgical  removal,  if  we  wish  to  learn 


DIETETIC   TREATMENT       147 

all  the  conditions  which  lead  up  to  the 
tumor  formation  and  its  recurrence  after 
operation. 

Long  ago  Abernethy  wrote :  ' '  There  can 
be  no  subject  which  I  think  more  likely  to 
interest  the  mind  of  the  surgeon  than  that 
of  an  endeavor  to  amend  and  alter  the 
state  of  a  cancerous  constitution.  The  best 
timed  and  best  conducted  operation  brings 
with  it  nothing  but  disgrace,  if  the  diseased 
propensities  of  the  system  are  active  and 
powerful.  It  is  after  an  operation  that,  in 
my  opinion,  we  are  most  particularly  in- 
cited to  regulate  the  constitution,  lest  the 
disease  should  be  revived  or  renewed  by  its 
disturbance.  *  * 

What  then  are  the  causes  of  this  dis- 
turbed condition,  and  what  are  the  means 
of  rectifying  them?  The  causes  lie  in  the 
various  elements  which  compose  what  we 
call  modem  civilization,  and  the  escape 
from  the  disease  lies  in  returning  to  the 
simple  life  and  the  avoidance  of  the  causes 
of    degeneration.      Statistical    and    other 


148  MEDICAL  ASPECTS  OF  CANCER 

proof  has  been  presented  elsewhere  to 
show  that  luxurious  living,  which  includes 
the  use  of  much  animal  food,  coffee  and 
tea,  and  alcohol,  together  with  indolence, 
or  want  of  sufficient  muscular  activity  to 
burn  up  the  waste  products,  in  connection 
with  the  persistent  neglect  of  hygienic 
laws,  should  be  placed  first  among  the 
causes  of  cancer.  In  one  decade  in  Eng- 
land it  was  found  that  cancer  mortality 
was  more  than  twice  as  great  among  well- 
to-do  men  having  no  specific  occupation, 
as  among  occupied  males  in  general,  the 
ratio  being  96  to  44.  Furthermore,  it  is 
now  well  recognized  that  the  refining, 
preparation,  and  cooking  of  food  often  in- 
terferes with  the  proper  supply  of  mineral 
and  other  elements  of  nutrition  necessary 
to  the  system. 

I  know  that  it  will  at  once  be  claimed 
that  the  disease  occurs  also  among  the 
poorer  classes,  who  cannot  be  said  to  be 
subject  to  ^ luxurious  living.'*  But  this 
latter  is,  after  all,  only  a  relative  term, 


DIETETIC   TREATMENT       149 

and  we  know  that  the  poor  continually  do 
indulge  in  erroneous  eating  and  drinking 
to  a  degree  which  does  disturb  metabo- 
lism in  many  directions,  and  we  know 
what  a  large  class  of  disorders  of  various 
kinds  are  thus  occasioned  among  them.  It 
has,  however,  been  definitely  shown  in 
England,  where  statistics  are  accurately 
kept  and  analyzed,  that  cancer  is  very 
much  more  prevalent  per  100,000  in  those 
parts  of  cities  which  are  occupied  by  the 
well-to-do  than  in  the  poorer  sections. 

The  guiding  of  the  diet  for  these  cases 
is  often  not  a  simple  matter.  Protein  the 
system  must  have,  to  build  up  and  regen- 
erate the  cell  life  of  the  body.  But  the  ox 
and  the  sheep  get  their  protein,  and  even 
the  iron  which  man  seeks  in  their  flesh, 
from  the  ground,  and  the  vegetable  king- 
dom contains  abundant  protein  and  min- 
eral substances,  even  for  man,  if  they  are 
rightly  sought  for.  And  it  is  recognized 
that  herbivorous  animals,  as  also  primitive 
races  who  subsist  on  the  products  of  the 


150  MEDICAL  ASPECTS  OF  CANCER 

ground,  are  relatively  or  quite  free  from 
cancer,  whereas  carnivorous  animals,  as 
also  domesticated  dogs  and  cats,  are  espe- 
cially prone  to  the  disease ;  and  it  has  been 
repeatedly  shown  experimentally  that  a 
purely  vegetarian  diet  inhibits  or  greatly 
diminishes  the  receptivity  of  inoculation 
with  cancer  material  in  mice. 

But  it  is  rarely  satisfactory  to  simply 
order  the  cancer  subject  to  subsist  on  a 
vegetarian  diet  without  some  special  direc- 
tions in  regard  to  the  same;  this  is  espe- 
cially true  in  regard  to  the  poorer  and 
more  ignorant  classes,  and  when  it  is  at- 
tempted it  is  surprising  to  see  how  much 
they  depend  on  animal  food  in  some  form 
or  other. 

To  aid  in  understanding  and  carrying 
out  treatment  perfectly  in  the  out-patient 
clinic  for  the  medical  treatment  of  cancer, 
at  the  New  York  Skin  and  Cancer  Hospital, 
a  four-page  card  has  been  prepared  which 
is  given  to  each  patient,  with  instructions 
to  study  it  and  carry  out  every  detail  per- 


DIETETIC   TEEATMENT       151 

fectly.  On  the  outer  sides  are  instructions 
in  regard  to  cancer,  and  the  danger  of 
neglect,  together  with  directions  in  regard 
to  the  preparation  and  consumption  of 
food,  mode  of  life,  etc.;  and  on  the  inside 
pages  a  menu,  or  diet  list,  for  each  meal, 
for  six  days,  which  is  here  presented. 
This  is  to  be  repeated  over  and  over  again, 
and  by  this  means  the  same  diet  does  not 
fall  on  the  same  day  of  each  week. 

DIET  FOR  CANCER 


Breakfast 

FIBST    DAY 

Dinner 

4  ounces  Rice                       5  ounces  Vegetable  soup 
3       *'       Corn  bread            3       "       Baked  potatoes 
1^4    "       Butter                    3       "       Stewed  celery 
%    "       Sugar                     3       "       ounces  Corn 
Hot  water                       1       "       Graham  bread 
134    "       Butter 
1  Fresh  apple 

Supper 

4  ounces  Rolled  oats 
2       "       White  bread 
1^    "        Butter 
4        "        Stewed  prunes 
34    "        Sugar 
Very  weak  tea 

152  MEDICAL  ASPECTS  OF  CANCER 


sEcosrp  r>AY 


Breakfast 


Orange 
4  ounces  Hominy 
2       "       Graham  toast 
1%    "       Butter 
Va    "       Sugar 
Postum 


Dinner 


5  ounces  Pea  soup 
3        "        Macaroni 
3        "        String-beans 
3        "        Carrots 
2       "       Bread 
114    "       Butter 
Dates 


Supper 
4  ounces  Cream  of  wheat 


2 

2 

1% 


Graham  toast 
Baked  apple 
Crackers 
Butter 
Sugar 
Very  weak  tea 


THIED  DAY 


Breakfast 

Banana 
4  ounces  Petti  John 
2       '•       White  bread 
1%    "       Butter 
Va    "       Sugar 
Hot  water 


Dinner 


5  ounces  Corn  soup 


3 
3 
3 
2 


Baked  potatoes 
Spinach 
Boiled  onions 
Bread 
Butter 
Raisins 


Supper 

4  ounces  Farina 
4       "       Stewed  figs 
2       '*       Graham  crackers 
1%    "       Butter 
14    "       Sugar 
Very  weak  tea 


DIETETIC   TREATMENT       153 


FOURTH   DAY 


Breakfast 


Raw  apple 
4  ounces  Cornmeal  mush 
2       "       Graham  bread 
134    "       Butter 
Va    "       Sugar 
Postum 


Dinner 


5  ounces  Vegetable  soup 


4 
3 
3 
2 
1^ 


Baked  beans 

Cauliflower 

Asparagus 

Bread 

Butter 


Orange 


Supper 

4  ounces  Rice 

4       "       Stewed  prunes 
2       •'       Graham  crackers 
1^4    "       Butter 
%    "       Sugar 
Very  weak  tea 


Breakfast 


FIFTH   DAY 


Orange 
4  ounces  Cracked  wheat 
3        "        Corn  muffins 
1%    "■    ~  Butter 
%    "       Sugar 
Hot  water 


Dinner 


5  ounces  Sago  soup 


4 
3 
3 
3 


Spaghetti 

Lima  beans 

Corn 

Boiled  onions 

Butter 


Dates 


Supper 

4  ounces  Cream  of  wheat 

Sliced  orange 
2  ounces  Oatmeal  crackers 
1%,    "       Butter 

^    "       Sugar 
Very  weak  tea 


154  MEDICAL  ASPECTS  OF  CANCER 


SIXTH    DAY 


Breakfast 


Dinner 


4  ounces  Samp 

2       "       Graham  toast 

1^    "       Butter 

Va    "        Sugar 

Postum 


5  ounces  Celery  soup 


4 
3 
3 

2 


Figs 


Baked  potatoes 

Carrots 

Spinach 

Butter 

Bread 


Supper 

4  ounces  Wheatena 
4        "        Stewed  figs 
2       "       Uneeda  biscuit 
1%    "       Butter 
%    "       Sugar 
Very  weak  tea 


This  diet  list  has  been  pretty  carefully 
worked  out,  so  that  it  totals  an  average  of 
about  2,200  calories  for  each  day,  with  140 
of  vegetable  protein,  and  a  proper  propor- 
tion of  fats  and  carbohydrates.  For  some 
months*  this  has  been  used,  both  in  the 
hospital  and  in  private  practice,  with  very 
satisfactory  results,  and  patients  have 
thrived  on  it  and  increased  in  weight.  It 
may  be  interesting  to  give  also  the  contents 


*  At  the  time  of  this  publication  it  has  been  em- 
ployed for  four  years  in  scores  of  cases  with  most 
satisfactory  results. 


DIETETIC   TREATMENT       155 

of  the  last  page,  which  contains  directions 
to  assist  in  carrying  out  this  line  of  treat- 
ment: 

*  *  Some  interchange  of  the  different  arti- 
cles may  be  made  according  to  the  season 
and  to  suit  the  appetite  or  convenience  of 
patients;  but  in  the  main  this  bill  of  fare 
should  be  followed,  with  occasional  substi- 
tution of  similar  articles,  if  necessary. 

**  Bread  at  least  twenty-four  hours  old 
may  be  taken  as  desired. 

"A  little  old  cheese  may  be  grated  on 
the  macaroni  and  spaghetti,  but  not  cooked 
with  it. 

**One  boiled  or  poached  egg  may  be 
taken  for  breakfast  every  other  day,  and 
very  fat  bacon  on  the  alternate  days,  un- 
less otherwise  directed  by  the  physician. 

*^It  is  desirable  to  eat  the  skins  of  pota- 
toes, baked  or  boiled. 

*^Each  and  every  meal  should  be  eaten 
very  slowly,  for  half  an  hour,  with  long 
chewing. 

*  *  One  tumbler  of  water,  not  iced,  is  to  be 


156  MEDICAL  ASPECTS  OF  CANCER 

taken  with  each  meal,  but  not  when  food 
is  in  the  mouth;  also  a  tumblerful  of  hot 
water  one  hour  before  breakfast  and  sup- 
per. 

^^No  milk  is  taken  unless  specially  or- 
dered, and  this  should  be  done  very  rarely. 

**The  vegetable  soups  are  made  from  a 
stock  composed  of  the  water  in  which  all 
the  vegetables  for  the  family  have  been 
boiled,  including  potatoes,  added  to  day  by 
day,  and  allowed  to  evaporate;  a  portion 
of  this  is  each  day  thickened  as  desired 
with  barley,  rice,  farina,  sago,  vermicelli, 
etc. 

**The  cereals  are  to  be  boiled  with  water, 
three  or  four  hours,  and  may  be  cooked  in 
the  afternoon  and  heated  in  the  morning, 
adding  more  water.  Rice,  farina,  and 
cream  of  wheat  require  only  an  hour. 
Chopped  dates,  figs,  raisins,  or  currants 
may  be  added  to  cereals  when  desired. 

**A11  the  cereals  are  to  be  served  very 
hot,  on  hot  plates,  and  eaten  with  butter 
and  salt  to  taste   (not  milk  and  sugar). 


DIETETIC   TEEATMENT       157 

They  are  to  be  eaten  very  slowly  with  a 
fork,  and  very  well  chewed. 

**The  crackers  with  supper  may  be 
varied  to  suit  the  taste;  they  should  be 
eaten  dry,  with  butter,  and  chewed  very 
thoroughly. 

**  Nothing  should  be  taken  between 
meals,  unless  especially  directed,  and  the 
life  should  be  as  simple  and  healthful  as 
possible,  with  early  and  long  bed  hours.'' 

The  physician,  therefore,  who  would  suc- 
cessfully overcome  a  cancerous  blood  state, 
whether  in  a  very  early  stage  of  the  tumor 
or  in  its  fuller  development,  or  even  when 
it  has  recurred,  must  fully  realize  the  grav- 
ity of  the  problem  involved  and  the  seri- 
ousness of  the  work  he  has  undertaken. 
He  must  study  and  strive  to  understand 
metabolism  and  its  relation  to  the  nutrition 
of  the  tissues.  He  must  make,  or  have 
made,  very  frequent  volumetric  studies  of 
the  urine,  in  regard  to  all  its  ingredients, 
and  grasp  and  rightly  interpret  the  find- 
ings, certainly  weekly,  in  connection  with 


158  MEDICAL  ASPECTS  OF  CANCEE 

the  diet  and  medication  of  the  patient, 
which  must  be  guided  thereby,  for  it  must 
be  remembered  that  imperfect  and  deficient 
urinary  secretion  is  a  common  forerunner 
and  accompaniment  of  cancer. 

He  must  also  watch  and  study  the  pa- 
tient in  all  aspects  of  life,  for,  as  shown  in 
the  work  already  alluded  to,  there  are  very 
many  elements  which  contribute  to  the  de- 
graded blood  stream  back  of  the  malignant 
disease  which  results  in  the  local  lesions 
which  we  call  cancer.  Bad  sanitation  of  all 
kinds,  mental  shock,  strain,  and  worry,  ir- 
regular bed  hours,  imperfect  or  neglected 
intestinal  excretion,  rapid  eating  and  im- 
perfect mastication,  and  a  thousand  errors 
in  eating  and  drinking,  all  contribute  to 
this,  which  cannot  be  treated  of  in  a  brief 
article,  but  are  more  or  less  developed  in 
the  reference  mentioned. 

It  is  readily  seen,  therefore,  that  the  die- 
tetic and  medical  treatment  of  cancer  can- 
not be  compassed  in  a  small  space.  Nor 
can  it  be  acquired  or  accomplished  without 


DIETETIC   TREATMENT       159 

very  serious  and  continued  thought  and 
work  on  the  part  of  the  physician;  more- 
over, it  must  be  recognized  that  infinite 
patience  and  perseverance  on  the  part  of 
both  physician  and  patient  are  requisite  to 
overcome  a  condition  of  system  which  has 
been  slowly  developing  long,  long  before 
the  first  vestigium  or  trace  of  the  local 
lesion  has  been  deposited.  And  when  the 
malignant  local  process,  or  cancerous  mass, 
has  once  been  started,  and  especially  when 
it  has  become  at  all  well  developed,  and  its 
cells  are  giving  forth  a  secretion  or  hor- 
mone which  is  poisonous  to  animals  and  as- 
sists in  poisoning  the  blood  stream  and  de- 
generating its  corpuscular  elements,  it  is 
readily  seen  that  it  is  a  most  difficult  task 
to  reverse  the  wrong  metabolism,  to  regen- 
erate the  depraved  blood,  and  to  cause  the 
absorption  or  return  to  normal  of  the  dis- 
eased cells  forming  the  tumor.  However, 
this  dietetic  treatment  must  be  continued  a 
very  long  time,  or  indefinitely,  in  order  to 
obtain  satisfactory  and  permanent  results. 


160  MEDICAL  ASPECTS  OF  CANCER 

But  that  this  latter  can  happen  is  abun- 
dantly shown  by  occasional  cases  of  un- 
questioned cancer  known  to  have  entirely 
disappeared  for  many  years,  and  some- 
times reported,  and  also  by  my  own  experi- 
ence during  the  last  thirty  or  forty  years, 
as  detailed  somewhat  in  the  work  already 
referred  to. 

But  it  must  be  here  understood  that,  in- 
asmuch as  a  well-developed  cancerous 
mass  has  already  become  a  menace  to  the 
system,  by  the  degenerative  properties  of 
its  secretion  or  hormone,  it  may  be,  and 
often  is,  desirable  to  remove  the  same, 
whether  by  the  knife,  a;-ray,  radium,  or 
even  caustics.  But  this  local  treatment  or 
removal  of  the  local  product  of  disease  can 
seldom,  if  ever,  be  undertaken  alone  with  a 
positive  expectation  of  a  permanent  cure, 
unless  proper  measures  are  faithfully  and 
persistently  carried  out,  almost  indefi- 
nitely, *^to  alter  and  amend  the  state  of  a 
cancerous  constitution,  lest  the  disease 
should  be  revived  or  renewed  by  its  dis- 


DIETETIC   TEEATMENT       161 

turbance/'  as  Abernethy  so  wisely  re- 
marked long  ago. 

I  am,  of  course,  quite  conversant  with 
the  good  and  even  permanent  results 
which  may  follow  the  local  treatment  of 
cutaneous  epithelioma,  whether  by  caustics, 
x-rsij,  radium,  thorium  paste,  or  the  knife ; 
but  these  local  lesions,  which  rarely  me- 
tastasize, should  be  distinguished  from  can- 
cer of  the  breast  and  internal  organs, 
which  furnish  the  bulk  of  the  distressing 
cases  which  thus  far  have  baffled  control. 

The  dietetic  treatment  of  true  cancer, 
then,  both  prophylactic  and  active,  consists 
in  an  absolutely  vegetarian  diet,  so  rightly 
proportioned  in  its  vegetable  protein,  car- 
bohydrates and  fats  as  to  afford  perfect 
nutrition,  and  so  arranged  and  adminis- 
tered as  to  be  acceptable  and  attractive,  in 
order  that  the  patient  may  be  constantly 
conscious  of  a  general  well-being  and  ex- 
hibit a  steadily  improved  state  of  health. 
All  this  and  other  treatment  should  be 
carried  on  with  confidence  and  an  expecta- 


162  MEDICAL  ASPECTS  OF  CANCEE 

tion  of  good  results,  for  undoubtedly  faith 
and  hope  contribute  greatly  to  all  thera- 
peutic success,  whereas  the  despondency  at- 
tending the  existence  of  cancer,  and  its  re- 
puted incurability,  also  contribute  much  to 
the  disastrous  results  commonly  observed. 
The  actual  medical  treatment  of  cancer 
cannot  be  briefly  detailed,  as  may  be 
judged  from  what  has  preceded,  and  be- 
cause individual  cases  may  require  most 
different  therapy  to  meet  individual  re- 
quirements; but  some  salient  points  may 
be  mentioned.  There  is  not,  and  probably 
never  will  be,  any  single  remedy,  or  spe- 
cific, ^*good  for  cancer;^'  although  innu- 
merable remedies,  quack  and  other,  have 
been  vaunted,  only  to  vanish  after  their 
uselessness  or  worse  had  been  demon- 
strated by  the  disappointed  hopes  of  many 
credulous  sufferers.  The  very  nature  of 
the  disease  would  indicate  this,  and  would 
also  indicate  that  no  serum  or  vaccine 
would  ever  be  found  which  could  perma- 
nently e:ffect  a  change  in  the  metabolic  con- 


MEDICAL  TEEATMENT        163 

ditions  inducing  the  tumor  formation,  and 
the  subsequent  disastrous  systemic  condi- 
tions ending  in  death.  It  is,  therefore,  not 
proposed  to  offer  any  new  or  special  rem- 
edy which  can  cure  the  disease. 

But  everything  can  be  done,  and  very 
much  should  be  done,  both  in  the  very  early 
stages  and  late  in  the  disease,  for  experi- 
ence shows  that  these  can  have  a  profound 
effect  in  influencing  the  metabolic  errors 
productive  of  cancer,  or  the  precancerous 
conditions,  as  I  have  already  pointed  out; 
these,  with  proper  dietetic  treatment,  and 
attention  to  every  hygienic  detail,  can  not 
only  check  the  cancerous  process  when 
once  begun,  but  can  cause  the  entire  re- 
moval of  early  lesions,  and  even  those  later 
in  the  disease,  including  metastases.  It  is 
understood,  of  course,  that  this  involves 
months  of  time,  and  with  so  terrible  and 
treacherous  a  disease  proper  measures 
may  be  required  indefinitely. 

First  in  importance  in  connection  with 
the    internal    treatment    of    cancer    come 


164  MEDICAL  ASPECTS  OF  CANCER 

measures  which  relate  to  body  elimination, 
which  is  found  to  be  imperfect  in  both  the 
early  and  late  stages  of  the  disease,  as  I 
have  shown  elsewhere. 

Constipation,  or  imperfect  intestinal  ac- 
tion, or  intestinal  stasis,  as  it  is  now  called, 
is  a  prominent  feature,  both  in  very  early 
cases  and  in  those  well  developed.  So  con- 
stantly have  I  observed  this,  in  large  num- 
bers of  cases,  that  I  have  come  to  look  up- 
on toxic  infection  from  the  millions  of  mi- 
cro-organisms in  retained  feces  as  one  of 
the  chief  elements  in  the  degeneration  of 
the  blood  stream  which  leads  up  to  cancer. 
And  this  cannot  receive  too  much  care  and 
attention  from  the  physician  in  charge,  and 
should  be  looked  into  so  constantly  as  to 
secure  a  free,  normal  action  of  the  bowels 
after  breakfast  and  even  oftener.  It  is  im- 
possible to  go  into  details  of  this  homely 
matter,  but  I  can  hardly  speak  too  strongly 
of  the  importance  of  it,  as  I  have  learned 
from  experience.  It  is  not  enough  to  give 
purgatives  from  time  to  time,  nor  do  I  find 


MEDICAL  TREATMENT        165 

the  use  of  mineral  waters  is  desirable  in 
these  cases.  I  much  prefer  the  vegetable 
laxatives  very  judiciously  administered, 
which  can  commonly  be  diminished  or  dis- 
pensed with  under  the  effect  of  proper  food 
and  abdominal  massage. 

The  urinary  excretion  is  invariably  dis- 
turbed in  cancer,  and  even  very  early  in 
the  disease  indicates  errors  in  the  blood 
stream  which  should  be  most  carefully 
watched  and  attended  to.  Few  realize  that 
the  urine  is  secreted  directly  from  the  ar- 
terial blood,  after  it  has  received  its  nutri- 
ment from  the  alimentary  canal  and  has 
been  submitted  to  the  action  of  the  secre- 
tions of  the  various  organs,  including  the 
ductless  glands,  as  also  to  its  oxygenation 
by  the  lungs.  The  kidneys  therefore  must 
be  looked  upon  as  the  final  judge  and  jury, 
in  determining  what  perfect  blood  should 
be,  exhibiting  in  their  secretion  the  results 
of  their  efforts  to  remove  elements  injuri- 
ous to  the  system  and  to  keep  the  blood 
in  a  normal  state.    When  we  speak,  there- 


166  MEDICAL  ASPECTS  OF  CANCER 

fore,  of  influencing  the  urine  by  dietary  or 
other  treatment,  it  only  refers  to  the  em- 
ployment of  such  measures  and  remedies 
as  shall  rightly  regulate  the  nutrition  of 
the  system,  promote  perfect  metabolism 
and  secure  adequate  and  normal  elimina- 
tion of  injurious  products. 

In  this  sense,  then,  the  urine,  if  very  fre- 
quently and  completely  studied  volumetri- 
cally,  in  its  very  many  components,  and 
correctly  interpreted,  affords  us  one  of  the 
very  best  aids  in  understanding  and  cor- 
recting the  metabolic  errors  which  underlie 
cancer.  Mention  has  already  been  made 
that  the  nitrogen  partition  in  the  urine  is 
generally  at  fault  in  cancer,  as  shown  by 
repeated  research  laboratory  reports;  the 
urea  is  low  and  the  acidity  high,  and  alka- 
lies, especially  the  acetate  and  citrate  of 
potassa,  play  a  considerable  part  in  the 
overcoming  of  the  systemic  error. 

But,  as  already  stated,  it  is  clearly  im- 
possible to  give  briefly  and  at  all  clearly 
any  line  of  treatment  which  is  to  be  invari- 


MEDICAL  TREATMENT        167 

ably  followed  for  the  months  or  years  nec- 
essary to  overcome  the  cancerous  condi- 
tion. For  it  mnst  be  remembered  that,  as 
in  regard  to  tuberculosis,  whose  death-rate, 
according  to  the  United  States  mortality 
tables,  has  fallen  over  25  per  cent,  since 
1900,  by  prolonged  proper  feeding  and  pro- 
longed medical  care,  so  in  regard  to  a  sim- 
ilarly chronic  condition,  cancer,  there  may 
be  the  need  of  any  number  of  remedies 
from  time  to  time  to  accomplish  the  end 
desired.  This  is  no  idle  comparison,  and 
only  by  recognizing  the  disordered  consti- 
tutional state  in  cancer  subjects,  and  by 
appl}dng  the  most  careful  and  intelligent 
medical  measures,  with  proper  diet  and 
hygiene,  can  we  overcome  this  dire  disease, 
or  prevent  its  occurrence.  But  that  this 
certainly  can  be  accomplished  in  a  very 
much  larger  percentage  of  cases  than  is 
obtained  by  our  present  general  method  of 
surgery,  etc.,  has  been  abundantly  shown, 
and  that  with  the  general  adoption  of  these 
views  by  the  profession  and  laity  there  will 


168  MEDICAL  ASPECTS  OF  CANCER 

be  a  material  diminution  in  the  morbidity 
and  mortality  of  cancer  is  equally  certain. 
It  will  undoubtedly  take  a  long  time  to  ef- 
fect a  startling  change  in  the  general 
death-rate  from  cancer,  but  with  the  faith- 
ful and  continued  application  of  these 
principles  there  can  be  little  doubt  but  that 
time  will  show  a  steady  diminution  in  the 
morbidity  and  mortality  from  this  disease 
comparable  at  least  to  the  twenty-five  per 
cent,  reduction  which  has  occurred  m  tu- 
berculosis since  1900,  by  proper  hygienic 
and  dietetic  measures. 


CHAPTER  IX 

NON-SUEGICAL    TKEATMENT    OF    CANCER 

What  is  cancer?  Laboratory  and  other 
investigations  have  failed  to  answer  the 
question,  except  to  agree  that  it  is  a  mor- 
bid disturbance  of  cells  of  the  body  which 
once  were  normal.  But  what  is  it  that  de- 
termines the  development  of  certain  of  the 
cellular  elements  of  the  body  into  healthy 
or  diseased  tissue?  It  is  the  condition  of 
the  blood  stream,  influenced  by  a  number 
of  disturbing  agencies,  all  working  through 
what  is  known  as  metabolism.  According 
as  this  is  correct  or  deranged  we  have 
health  or  many  conditions  to  which  we  give 
the  names  of  various  diseases.  No  one 
doubts  that  rickets  is  due  to  such  a  cause, 
nor  does  any  one  question  but  that  acute 
gout  results  from  a  disordered  state  of  the 
blood.  Diabetes  and  lithaemia  give  rise  to 
169 


170  MEDICAL  ASPECTS  OF  CANCER 

many  other  symptoms  than  those  mani- 
fested by  the  kidney  excretion. 

The  question  now  arises,  what  are  the 
causes  of  a  deranged  blood  stream?  First 
must  come  erroneous  eating  and  drinking, 
as  shown  in  the  case  of  rickets  and  gout. 
Next,  faulty  action  of  some  of  the  organs 
of  the  body,  induced  in  many  other  ways, 
which  need  not  be  entered  on  here,  as  they 
are  familiar  to  all. 

The  blood  is  the  life,  and  vast  amounts 
of  labor  and  patience  have  been  expended, 
and  many  books  written,  on  the  character 
of  the  blood  in  various  diseased  states  of 
the  system,  although  not  many  years  ago 
only  ridicule  was  given  to  one  who  used 
the  expression  ^'bad  blood."  We  certainly 
owe  much  to  laboratory  investigations :  for 
recent  works  show  very  many  and  great 
changes  in  it  in  many  diseases,  including 
cancer. 

But  unfortunately  most  of  the  efforts 
have  been  in  connection  with  the  micro- 
scopic examination  of  the  corpuscular  ele- 


NON-SUEGICAL  TEEATMENT  171 

ments  of  the  blood,  and  very  little  atten- 
tion has  been  paid  to  their  chemical  consti- 
tution or  to  the  plasma.  And  yet  this  latter 
is  of  the  utmost  importance,  as  from  it  are 
derived  the  nutrient  principles  not  only  of 
the  solid  constituents  of  the  blood,  but  also 
those  of  the  entire  system,  about  8  per  cent. 
of  it  being  serum  albumen  and  serum  glob- 
ulin. It  also  holds  in  solution  the  phos- 
phates, carbonates,  sulphates,  and  chlor- 
ides, the  latter  often  varying  greatly,  and 
being  chiefly  responsible  for  the  isotonic 
relation  of  cells  and  serum. 

Unfortunately,  also,  most  of  these 
studies,  as  also  those  of  the  urine,  and  in- 
deed most  laboratory  investigations,  have 
been  made  in  connection  with  cases  of  ad- 
vanced cancer,  when  the  metabolic  disorder 
which  led  up  to  the  tumor  formation  had 
existed  long,  and  even  when  vital  organs 
are  involved  by  the  disease,  and  so  teach  us 
little  in  regard  to  the  true  causes  of  cancer. 
What  we  need  are  more  researches  on  pre- 
cancerous conditions  of  the  system,  and 


172  MEDICAL  ASPECTS  OF  CANCER 

those  belonging  to  the  very  earliest  stages 
of  the  disease.  For  just  as  the  earliest 
possible  recognition  of  cancer  has  been  em- 
phasized strongly  in  connection  with  its 
surgical  treatment,  so  also  the  earlier  these 
conditions  are  recognized  and  met  by 
proper  dietary  and  medical  treatment,  the 
better  the  prospect  of  success,  as  experi- 
ence has  taught  me,  during  the  last  thirty 
and  more  years. 

In  speaking,  therefore,  of  the  non-surgi- 
cal treatment  of  cancer  this  last  qualifica- 
tion is  to  be  borne  well  in  mind.  While 
in  some  instances  it  is  possible  to  do  very 
much  for  very  advanced  cases,  by  exactly 
the  proper  dietary  and  other  measures,  so 
that  sometimes  even  recurrent  lesions  will 
melt  away  and  metastases  disappear,  it  is 
unreasonable  to  expect,  with  our  present 
knowledge  of  this  line  of  practice,  to  check 
the  disease  readily  in  the  many  cases  now 
recognized  as  surgically  hopeless,  varying 
from  50  to  80  per  cent,  of  all  those  affected. 
As  early  lesions  in  the  breast,  in  which  my 


NON-SURGICAL  TREATMENT  173 

experience  mostly  lies,  may  certainly  be 
made  to  disappear  and  remain  absent  in- 
definitely, so  it  is  hoped  and  believed  that 
as  the  proper  principles  of  living  and  med- 
ical treatment  are  recognized  and  ai- plied, 
there  will  be  a  steady  diminution  in  the 
morbidity  and  consequent  mortality  of  can- 
cer. And  as  scientific  study  proceeds  along 
metabolic  lines  it  is  quite  possible  that  pri- 
mary cancer  of  internal  organs  now  so 
fatal,  will  share  in  the  better  understand- 
ing of  its  nature  and  cause. 

Cancer,  that  is  the  localized  tumor  or 
mass  which  we  recognize  as  such,  undoubt- 
edly begins  in  some  particular  locality  as  a 
local  disease.  But,  as  Ribert  says,  **no  one 
has  ever  seen  the  beginning  of  mammary 
cancer,"  and  no  one  knows  just  how  the 
first  change  takes  place  from  a  normal  to 
a  malignant  cell;  and  yet  undoubtedly 
there  is  a  time  and  cause  of  the  same.  But 
how  does  it  occur? 

The  laboratory  has  excluded  about  every 
possible  cause  except  faulty  metabolism. 


174  MEDICAL  ASPECTS  OF  CANCER 

and  the  more  the  reported  findings  along 
this  line  are  studied  and  analyzed,  the  more 
evident  does  it  appear  that  here  will  be 
found  the  solution  of  the  very  serious 
problem  of  the  prevention  and  cure  of  can- 
cer, as  I  have  shown  elsewhere.  The  agi- 
tation in  regard  to  the  very  early  recogni- 
tion of  cancer  is  most  laudable,  but  an  agi- 
tation to  discover  the  basic  cause  which 
leads  up  to  tumor  formation  is  far  more 
desirable.  To  merely  attack  or  cut  out  the 
local  manifestation  of  the  disease,  the 
tumor,  while  leaving  the  primal  cause  still 
operative,  to  produce  new  lesions  or  a  re- 
currence, which  so  commonly  occurs,  seems 
about  as  sensible  as  to  remove  surgically, 
one  after  another,  the  late  cutaneous  or 
other  lesions  of  syphilis. 

Statistics  have  shown  conclusively  that 
cancer  mortality  is  steadily  increasing  with 
the  advance  of  civilization.  Primitive  peo- 
ple, living  simple  lives,  largely  on  vege- 
tarian products,  are  known  to  be  almost  if 
not  entirely  free  from  cancer,  but  as  they 


NON-SUKGICAL  TREATMENT  175 

mingle  with  foreigners  and  adopt  their 
ways  of  eating  and  living,  the  disease  ap- 
pears more  frequently  in  them. 

All  along  the  past  one  hundred  years  one 
may  find  repeated  declarations  in  favor  of 
a  constitutional  cause  of  cancer,  largely 
based  on  dietary  errors  and  violation  of 
hygienic  living.  Such  statements  have 
been  repeatedly  made  by  surgeons  and 
those  who  knew  cancer  well,  and  realized 
how  relatively  impotent  purely  surgical 
measures  are  to  stay  its  increasing  mortal- 
ity rate,  now  reaching  about  90  per  cent, 
of  those  once  affected :  Lambe,  Abernethy, 
Willard  Parker,  Sir  Astley  Cooper,  Sir 
James  Paget,  Benecke,  Esmarck,  Oldehop, 
Sir  Arbuthnot  Lane  and  latterly  William 
J.  Mayo,  have  all  spoken  in  no  uncertain 
terms  along  this  line  of  thought ;  but  their 
views  have  received  little  or  no  attention, 
and  the  craze  for  surgery  has  seemed  to 
blind  the  eyes  of  all. 

The  actual  details  of  the  non-surgical 
treatment  of  cancer  cannot  be  given  in  a 


176  MEDICAL  ASPECTS  OF  CANCEB 

brief  article,  they  are  often  so  complex  and 
far-reaching  in  connection  with  faulty 
metabolism.  There  is,  of  course,  no  single 
remedy,  n^r  ever  will  be,  which  will  cure 
the  disease ;  its  very  nature  precludes  this. 
Each  cancer  case  is  a  study  by  itself,  re- 
quiring careful  attention  to  details  in  very 
many  directions,  relating  to  every  phase  of 
life.  An  individual  with  an  ideal  metabo- 
lism will  never  develop  cancer. 

While  a  diet  devoid  of  animal  protein  is 
the  first  requisite  when  cancer  is  threaten- 
ing or  has  developed,  this  is  hard  to  en- 
force for  a  long  enough  period,  and  many 
patients  find  it  difficult  to  adjust  it  satis- 
factorily. There  is  need,  therefore,  that 
the  physician  should  understand  the  sub- 
ject well,  and  by  constant  inquiry  and  di- 
rection see  that  the  patient  takes  a  proper 
and  sufficient  number  of  calories,  rightly 
apportioned  in  vegetable  protein,  carbohy- 
drates, and  fat;  the  latter  may  be  largely 
made  up  by  butter,  of  which  a  quarter  of 
a  pound  daily  furnishes  800  calories. 


NON-SUEGICAL  TREATMENT  177 

The  medical  treatment  of  cancer  may  be 
as  varied  as  are  the  possibilities  of  meta- 
bolic disturbance,  and  also  cannot  be  briefly 
detailed.  But  all  measures  lie  mainly 
along  the  line  of  securing  proper  assimila- 
tion and  elimination.  Long  observation 
and  innumerable  quantitative  analyses  of 
the  urine  of  cancer  patients,  which  has  been 
measured  daily  for  weeks  and  months, 
show  that  the  solids  excreted  in  this  way 
are  always  deficient  in  quantity,  often  be- 
ing not  one  half  of  that  required  by  the 
body  weight  of  the  patient;  the  urine  is 
also  commonly  deranged  in  respect  to  the 
proportion  of  some  of  its  many  ingredi- 
ents. A  weekly  complete  volumetric  an- 
alysis is  therefore  a  valuable  guide  to  the 
therapeutic  measures  which  correct  these 
errors. 

Elimination  by  the  intestinal  tract  is  also 
found  to  be  almost  invariably  at  fault  in 
cancer  patients,  even  in  the  very  earliest 
stages.  So  true  is  this  that  Sir  Arbuthnot 
Lane  has  rightly  remarked  that  one  of  the 


178  MEDICAL  ASPECTS  OF  CANCER 

terminal  results  of  intestinal  stasis  may  be 
cancer.  So  universally  common  is  this  con- 
dition that  it  may  be  seriously  questioned 
if  the  toxins  produced  by  the  millions  of 
micro-organisms  generated  through  intes- 
tinal stasis  and  fecal  putrefaction  may  not 
be  the  real,  incidental  cause  of  the  disease, 
through  derangement  of  the  character  of 
the  blood  stream.  This  is  a  matter  which 
should  be  very  carefully  attended  to ;  it  is 
not  enough  to  give  occasional  cathartics, 
but  by  a  most  careful  and  repeated  super- 
vision to  secure  that  there  shall  be  at  least 
one  movement  of  the  bowels  daily,  as  near 
normal  as  possible.  These  may  seem  home- 
ly details,  but  as  in  the  surgery  of  cancer 
minute  attention  to  little  things  is  essen- 
tial, so  in  the  management  of  the  dietary 
and  medicinal  treatment  success  can  be 
achieved  only  by  the  most  exact  attention 
to  every  item  relating  to  the  health  and 
perfect  functioning  of  the  system. 

Of  the  particular  measures  of  service  in 
the  non-surgical  treatment  of  cancer  it  is 


NON-SUEGICAL  TEEATMENT  179 

impossible  to  speak  fully,  for  from  first  to 
last  they  may  include  a  great  variety  of 
remedies.  Alkalies  are  always  of  service, 
especially  the  salts  of  potassa,  acetate, 
citrate  and  phosphate.  Iron  is  commonly 
called  for,  in  large  quantities,  and  vege- 
table tonics  and  alteratives.  Thyroid  is 
often  of  value,  and  there  is  reason  to  be- 
lieve that  trypsin  and  amylopsin  are  of 
value,  when  used  in  connection  with  a 
vegetarian  diet. 

Locally  much  can  be  done  by  various 
measures,  both  to  remove  the  morbid 
growth  and  even  to  benefit  ulcerating  sur- 
faces. The  ^-ray  and  radium  have  cer- 
tainly proved  efficient  in  suitable  cases,  and 
thorium  paste,  when  rightly  used,  is  most 
valuable  in  modifying  and  removing  dis- 
eased epithelial  tissue,  etc. 

While  surgery  may  have  its  function  to 
perform  in  some  cases  of  cancer,  it  has  too 
long  been  a  mistake  to  delegate  the  disease 
wholly  to  the  surgeon,  certainly  unless 
suitable  measures  are  adopted  to  overcome 


180  MEDICAL  ASPECTS  OF  CANCER 

the  constitutional  tendency,  which  if  left 
unchecked  tends  to  reproduce  its  local 
product,  the  malignant  new  growth,  in  the 
scar  or  elsewhere,  as  so  constantly  occurs. 
It  is  high  time  to  revise  our  views  as  to 
the  true  pathology  of  cancer,  and  in  the 
light  of  modern  studies  on  metabolism  and 
nutrition  to  seek  to  solve  the  cancer  prob- 
lem by  other  measures  than  the  knife, 
which  has  thus  far  failed  to  check  the 
steadily  rising  mortality  of  over  twenty- 
five  per  cent,  since  1900,  according  to  the 
United  States  Mortality  Statistics. 


CHAPTER  X 

WHAT  DOES  THE  PATHOLOGY  OF  CANCEB 
TEACH  AS  TO  ITS  CURE?* 

Pathology  is  defined  by  Stedman  as 
**The  branch  of  medical  science  which 
deals  with  disease  in  all  its  relations,  es- 
pecially with  its  nature  and  the  functional 
and  material  changes  caused  by  it/'  The 
Standard  Dictionary  has  it:  ''The  branch 
of  medical  science  that  treats  of  morbid 
conditions,  their  causes,  nature,  etc.*' 

The  word  ''pathology,''  as  related  to 
cancer,  has  of  late  years  been  grossly 
abused,  and  confined  almost  exclusively  to 
the  histologic  changes  found  in  the  diseased 
tissue,  with  no  recognition  of  the  pathogen- 
esis or  true  pathology  of  the  disease.    In 


*  Read  before  the  Academy  of  Pathological  Science, 
New  York,  April  26,  1918. 

181 


182  MEDICAL  ASPECTS  OF  CANCER 

this  way  a  very  narrow  conception  of  can- 
cer has  been  fostered,  and  it  has  been  too 
generally  looked  npon  as  a  wholly  local  dis- 
ease, which  can  be  overcome  by  excision  of 
the  offending  mass.  A  correct  and  broader 
pathology,  however,  should  look  into  the 
constitutional  derangements  which  lead  to 
the  formation  of  the  local  lesion,  the  prod- 
uct of  some  deep-seated  metabolic  error. 
As  I  have  remarked  elsewhere,  ^'from  the 
enormous  work  which  has  been  done  on 
cancer  with  the  microscope  and  test  tube, 
it  would  seem  sometimes  that  research 
workers  have  become  somewhat  myopic, 
and  are  still  not  sufficiently  far-sighted  to 
recognize  the  true  value  of  statistical  stud- 
ies and  clinical  observation.'' 

In  view  of  the  steady,  startling  and  dis- 
tressing rise  in  the  death  rate  from  cancer, 
as  shown  in  the  recently  published  govern- 
ment volume  on  the  *^  Mortality  from  can- 
cer and  other  malignant  tumors  in  the  reg- 
istration area  of  the  United  States,"  is 
it  not  wise  to  stop  and  consider  what  it 


PATHOLOGY  OF  CANCER      183 

really  means,  and  if  there  is  any  way  to 
arrest  this  progressively  increasing  mor- 
bidity and  mortality?  For,  while  the  death 
rate  of  tuberculosis  has  fallen  almost  30 
per  cent,  since  1910,  that  of  cancer  has 
risen  in  1916  to  81.8  per  100,000,  or  an  in- 
crease of  29.84  per  cent.,  more  than  that  of 
any  other  disease !  The  mortalities  of  the 
two  diseases  have  therefore  approached 
each  other  almost  60  per  cent.,  and  if  the 
rate  of  both  continue  the  same,  the  deaths 
from  cancer  will  quite  exceed  those  from 
tuberculosis  in  16  years  more. 

Is  it  not  well,  therefore,  to  stop  and  con- 
sider whether  there  is  not  possibly  some- 
thing wrong  in  our  conception  of  cancer 
and  its  past  and  present  treatment?  The 
wonderful  results  of  a  proper  medical 
treatment  of  tuberculosis,  including  diet 
and  hygiene,  have  succeeded  in  reducing  its 
mortality  very  greatly;  whereas  the  neg- 
lect of  a  proper  medical  treatment  of  can- 
cer, including  diet  and  hygiene,  and  the  re- 
liance on  surgery  or  radium  to  simply  try 


184  MEDICAL  ASPECTS  OF  CANCER 

to  remove  the  offending  mass,  without  cor- 
recting the  underlying  condition  or  cause, 
has  resulted  only  in  a  steady  increase  in  the 
mortality  from  this  distressing  malady. 

It  is  therefore  high  time  for  us  to  study 
the  true  medical  pathology  of  the  disease. 
It  is  time  to  look  seriously  into  the  causes 
which  appear  to  have  accompanied  its  in- 
crease in  various  localities,  and  the  condi- 
tions of  life  which  have  been  observed  to 
be  associated  with  cancer.  It  is  time  to 
test  out  intelligently  and  thoroughly  a  line 
of  dietetic,  hygienic,  and  medicinal  treat- 
ment comparable  with  that  which  has  pro- 
duced such  brilliant  results  in  tuberculosis. 
Unless  this  is  done  faithfully  the  deplor- 
able, acknowledged,  ultimate  mortality  of 
about  90  per  cent,  of  those  once  attacked  by 
malignant  disease  will  not  be  lowered. 

The  enormous  amount  of  study  and  vast 
sums  of  money  which  have  been  expended 
on  the  laboratory  study  of  cancer  have  in- 
deed taught  us  much  in  regard  to  the  dis- 
ease, but  largely  along  negative  lines.    In 


PATHOLOGY  OF  CANCER      185 

order  that  we  may  understand  fully  the 
basis  on  which  our  present  study  rests  I 
can  not  do  better  than  to  quote  what  I  have 
said  in  a  former  article.*  The  results  of 
laboratory  and  other  study  of  cancer, 
which  are  pretty  well  conceded  by  those 
who  know  most  about  the  disease,  may  be 
grouped  under  two  heads,  negative  and 
positive,  eight  of  each. 

A.  Negative  results  of  laboratory  and 
other  study. 

1.  Clinically  and  experimentally  cancer 
is  shown  to  be  not  contagious  or  infec- 
tious ;  although  under  just  the  right  condi- 
tions, certain  malignant  new  growths  can 
be  inoculated  in  some  animals  of  the  same 
species,  but  not  in  other  species,  and  hu- 
man cancer  can  not  be  transplanted  on  ani- 
mals. 

2.  Although  micro-organisms  of  many 
kinds  often  have  been  found  and  claimed 
as  the  cause  of  cancer,  there  has  been  no 


♦The  real  cancer  problem.    Medical  Record,  March 
17,  1917. 


186  MEDICAL  ASPECTS  OF  CANCER 

concurrence  of  opinion  in  regard  to  tliem, 
and  it  is  now  pretty  conclusively  agreed 
that  cancer  is  not  caused  by  a  micro-organ- 
ism or  parasite. 

3.  Cancer  is  not  wholly  a  result  of  trau- 
matism; although  local  injury  may  have 
much  to  do  with  its  development  in  some 
particular  locality,  even  as  in  connection 
with  the  late  lesions  of  syphilis. 

4.  Cancer  is  not  hereditary  in  any  ap- 
preciable degree;  although  some  tendency 
in  that  direction  has  been  demonstrated  in 
certain  strains  of  mice. 

5.  Occupation  has  7iot  any  very  great  in- 
fluence on  the  occurrence  of  cancer;  al- 
though it  is  more  frequent  in  some  pur- 
suits than  in  others. 

6.  Cancer  is  not  altogether  a  disease  of 
older  years ;  although  its  occurrence  is  de- 
cidedly influenced  by  advancing  age. 

7.  Cancer  does  not  especially  belong  to 
or  affect  any  particular  sex,  race,  or  class 
of  persons. 

8.  Cancer  is  not  confined  to  any  location 


PATHOLOGY  OF  CANCEK      187 

or  section  of  the  earth,  but  has  been  ob- 
served in  all  countries  and  climates. 

But  while  laboratory  and  other  investi- 
gations have  not  demonstrated  any  single 
cause  of  cancer  and  have  yielded  only 
negative  results,  they  have,  by  elimination, 
cleared  the  way  for  a  study  of  its  cause 
along  other  lines,  which  are  bright  with 
promise.  They  have  also  established  cer- 
tain facts  which  confirm  the  views  which 
from  time  to  time  have  been  briefly  ex- 
pressed by  many  who  were  best  acquainted 
with  cancer;  namely,  that,  because  of  its 
constant  recurrence,  and  from  the  failure 
of  surgery  to  check  its  rising  mortality,  it 
must  be  of  a  constitutional  nature,  inti- 
mately associated  with  dietary  or  nu- 
tritional elements,  as  I  have  elsewhere 
shown. 

B.  The  positive  results  of  laboratory  in- 
vestigation are  more  encouraging : 

1.  We  know  now  that  the  local  mass, 
which  we  call  cancer,  represents  but  a  devi- 
ation from  the  normal  life  and  action  of 


188  MEDICAL  ASPECTS  OF  CANCER 

the  ordinary  cells  of  the  body.  These  once 
normal  cells  for  some  as  yet  unexplained 
reason,  take  on  an  abnormal  or  morbid  ac- 
tion, with  a  continued  tendency  to  a 
malignancy  which  invades  and  destroys 
contiguous  tissue,  and  is  associated  with  a 
progressive  anemia  which  destroys  life. 

2.  Microscopic  study  has  shown  that 
there  is  a  certain  change  in  the  polarity  of 
cells  about  to  be  cancer-genetic,  with  an  al- 
tered relation  of  the  centrosome  to  the  nu- 
cleus. These  changes  have  been  well  at- 
tributed to  an  alteration  in  the  enzyme  con- 
tained in  the  cell,  which  further  depends  on 
the  nutrition  of  the  cell  as  influenced  by  a 
faulty  metabolism  of  food  elements. 

3.  The  exclusion  of  all  other  possible 
causes  leads  us  naturally  to  look  to  a  dis- 
ordered metabolism  as  a  cause  of  the  dis- 
turbed action  of  the  hitherto  normal  cells ; 
and  we  find  much  to  confirm  this  view  both 
in  laboratory  studies  on  the  biochemistry 
of  cancer,  and  also  in  clinical  and  statisti- 
cal observations. 


PATHOLOGY  OF  CANCER      189 

4.  The  blood  in  advancing  cancer  has  re- 
peatedly been  shown  to  exhibit  many  mani- 
fest changes,  which  indicate  vital  altera- 
tion in  the  action  of  the  organs  which 
form  blood,  and  so  control  the  nutrition  of 
the  body  and  its  cells. 

5.  Laboratory  and  clinical  evidence  dem- 
onstrate that  the  secretions  and  excretions 
of  the  body,  both  in  early  and  late  stages 
of  cancer,  exhibit  departures  from  normal 
which  deserve  consideration.  Although 
none  of  these  have  as  yet  been  established 
as  pathognomonic  of  cancer,  they  neverthe- 
less indicate  metabolic  disturbances  which 
influence  the  nutrition  of  the  cellular  ele- 
ments, and  so  these  secretory  and  excre- 
tory disturbances  are  of  undoubted  impor- 
tance in  connection  with  its  causation. 

6.  As  all  healthy  cells  of  the  body,  by 
their  catabolism  and  anabolism  contribute 
a  hormone  or  something  to  the  general  cir- 
culation, so  experimental  evidence  shows 
that  the  cells  of  a  fully  developed  cancer 
mass    secrete    a   hormone    or    something 


190  MEDICAL  ASPECTS  OF  CANCER 

which  is  poisonous  to  animals,  and  which 
probably  hastens  the  lethal  progress  of  the 
disease. 

7.  Repeated  laboratory  experiences  have 
demonstrated,  in  a  most  remarkable  man- 
ner, the  absolute  controlling  effect  of  diet 
on  the  development  of  inoculated  cancer  in 
mice  and  rats,  so  that  the  process  was  in- 
hibited almost  entirely  with  certain  vege- 
table feedings. 

8.  We  thus  see  that  as  the  laboratory  has 
eliminated  the  local  nature  of  cancer,  it  has 
also,  in  a  measure,  established  the  fact  that 
there  are  medical  aspects  of  the  disease 
which  further  studies  will  show  to  be  of  the 
utmost  importance.  These  all  tend  to  dem- 
onstrate its  constitutional  origin,  that  is,  its 
relation  to  deranged  metabolism,  now  rec- 
ognized as  the  basis  of  so  many  diseases. 

C.  But  clinical  and  statistical  studies 
come  in  with  overwhelming  force  to  con- 
firm the  correctness  of  this  position. 

1.  We  have  already  seen  that  with  utter 
medical  neglect  the  death  rate  of  cancer 


PATHOLOGY  OF  CANCER      191 

has  steadily  and  greatly  increased  in  the 
United  States,  of  late  years,  in  spite  of  the 
prodigious  advances  in  surgery  during  the 
same  time.  This  is  also  true  in  all  the 
countries  from  which  we  have  any  accurate 
statistics.  We  know  also  that  tuberculosis 
as  a  result  of  careful  medical  attention,  has 
decreased  in  mortality,  by  almost  the  same 
percentage  as  cancer  has  increased.  The 
same  is  reported  by  reliable  observers  all 
over  the  civilized  world. 

2.  Any  number  of  observers,  in  many 
lands,  have  recorded  the  almost  entire  ab- 
sence of  cancer  among  aborigines,  living 
simple  lives,  largely  vegetarian ;  they  have 
also  shown  the  definite  increase  in  the  dis- 
ease, and  in  its  mortality,  in  proportion  to 
the  adoption  of  the  customs  and  diet  of  so- 
called  modern  civilization  by  the  same 
aborigines. 

3.  This  increased  cancer  mortality  seems 
to  depend  upon  the  altered  conditions  of 
life  attending  advanced  civilization,  par- 
ticularly along  the  lines  of  self-indulgence 


192  MEDICAL  ASPECTS  OF  CANCER 

in    eating    and    drinking    and    indolence. 

4.  Statistics  from  many  countries  show 
that  increase  in  the  consumption  of  meat, 
coffee,  and  alcoholic  beverages,  appears  to 
be  coincident  with  a  very  great  and  pro- 
portionately greater  augmentation  of  the 
mortality  from  cancer. 

5.  Clinical  observation  has  time  and 
again  shown  the  effect  of  specific  nerve 
strain  and  shock  in  the  development  of  can- 
cer; and  there  seems  to  be  little  question 
but  that  the  enormous  nerve  strain  of  mod- 
ern life  is  an  element  of  importance  in  this 
direction,  both  through  metabolic  distur- 
bance, and  by  direct  action  on  living  cells. 

6.  At  present  no  clear  demonstration  is 
possible  of  the  direct  method  by  which  er- 
rors of  metabolism  effect  the  changes  in 
cells  to  which  we  give  the  name  malignant, 
any  more  than  we  know  how  other  altera- 
tions on  the  body  are  produced,  such  as 
arterial  degeneration,  bone  changes,  obes- 
ity, etc.,  which  are  recognized  as  due  to 
metabolic  derangement. 


PATHOLOGY  OF  CANCER      193 

7.  The  results  which  have  been  observed 
in  connection  with  the  starvation  of  cancer, 
by  ligature  of  vessels,  illustrate  the  rela- 
tion of  the  blood  supply  to  growing  cancer. 

8.  Finally,  the  repeated  observation  and 
report  of  the  spontaneous  disappearance  of 
cancer,  by  careful  and  competent  medical 
men,  shows  that  conditions  of  the  system 
may  arise  which  are  antagonistic  to  malig- 
nant growth,  even  when  it  has  begun  to 
take  place;  just  as  there  are  other  condi- 
tions of  the  system  which  favor  the  aber- 
rant action  of  previously  normal  cells,  re- 
sulting in  cancer. 

The  medical  aspects  of  cancer  thus  loom 
large,  and  appear  in  quite  a  different  light 
from  that  in  which  they  have  been  common- 
ly viewed.  We  now  begin  to  see  some  of 
the  reasons  why  cancer  is  not  primarily  a 
surgical  disease,  and  some  of  the  lines 
along  which  observation  and  investigation 
should  proceed,  namely;  biochemistry,  se- 
cretory and  excretory  derangements,  met- 
abolic  disturbances,   diet,   etc.    The   sub- 


194  MEDICAL  ASPECTS  OF  CANCEE 

ject  is  too  new  a  one  to  afford  a  great 
amount  of  corroborative  proof  at  present, 
other  than  the  long  personal  experience  of 
the  writer  and  others,  who  have  seen 
tumors  disappear  under  means  other  than 
surgical,  x-rsij  and  radium.  More  clinical 
and  laboratory  investigations  of  human  be- 
ings are  needed,  and  not  only  simply  mi- 
croscopic studies  and  experiments  on  ani- 
mals, valuable  as  these  have  been  in  the  ad- 
vancements of  medical  science  in  connec- 
tion with  other  diseases. 

The  true  study  of  the  pathology  of  can- 
cer is  thus  seen  to  be  a  much  broader  field 
of  investigation  than  simply  histological 
and  test  tube  researches,  and  inoculation 
experiments  on  animals.  It  should  look  in- 
to its  causes.  It  covers  a  vast  ground :  1. 
The  nosological  relations  of  the  disease. 
2.  Its  ethnological  and  geographical  distri- 
bution. 3.  The  progress  of  civilization  in 
disturbing  the  normal  course  of  human 
life.  4.  The  changes  in  diet  and  nutrition 
which  lead  up  to  the  various  derangements 


PATHOLOGY  OF  CAXCER      195 

of  the  system,  involving  the  growth  of 
healthy  and  diseased  tissue,  including  tu- 
mors. 5.  The  biochemistry  of  the  system, 
with  the  blood  changes  which  precede  and 
accompany  cancer.  6.  The  share  of  the 
lymphatic  system  in  the  disease.  7.  The 
errors  of  metabolism  leading  to  cancer,  as 
shown  by  derangements  in  the  secretions 
and  excretions  of  the  endocrinous  and  sali- 
vary glands,  kidneys,  intestines,  etc.,  etc. 
8.  Indeed  the  proper  and  careful  study  of 
the  pathology  of  cancer  widens  out  into  the 
broadest  conception  of  human  life.  All  this 
is  quite  different  from  the  commonly  ac- 
cepted view,  which  regards  the  tumor  as 
a  chance  malgrowth,  only  requiring  the 
knife  to  remove  it,  without  any  thought  or 
attempt  to  reach  and  eradicate  the  cause, 
and  prevent  a  relapse,  which  occurs  in  such 
a  large  proportion  of  cases. 

Time  does  not  admit  of  a  full  considera- 
tion of  any  of  these  points,  much  less  the 
presentation  here  of  the  corroborative 
facts  demonstrating  the  constitutional  re- 


196  MEDICAL  ASPECTS  OF  CANCER 

lations  of  cancer,  all  of  which  have  been 
given  pretty  fully  in  the  books  referred  to. 
But  I  will  endeavor  to  briefly  direct  your 
attention  to  some  of  those  which  have  a 
practical  bearing  upon  the  prophylaxis  and 
cure  of  cancer.  We  will,  therefore,  very 
briefly  consider  the  points  above  mentioned 
in  order,  and  I  hope  to  satisfy  you  that 
cancer  is  more  than  a  strictly  local  disease 
and  that  the  local  lesion  is  but  the  product 
of  a  preceding  and  continuing  constitu- 
tional disorder,  which  must  be  met  and  al- 
tered if  we  hope  to  make  any  improvement 
in  its  frightful  morbidity  and  mortality. 
Also  I  trust  that  all  will  recognize  the  fu- 
tility of  hoping  that  the  mere  excision  of 
the  offending  mass  will  effect  a  permanent 
cure  in  any  large  proportion  of  cases. 

I  must  here  remind  you  that,  according 
to  the  special  report  on  ^*  Mortality  from 
Cancer  and  Other  Malignant  Tumors  in  the 
United  States,  in  1914, '*  epithelioma,  or 
cancer  of  the  skin,  furnished  only  about 
3  per  cent,  of  the  deaths,  and  cancer  of  the 


PATHOLOGY  OF  CANCER      197 

lip  only  0.6  of  the  deaths,  among  a  total 
mortality  of  81.8  in  each  100,000  of  the 
population.  And  yet  in  all  the  propaganda 
regarding  the  value  of  surgical  work  in 
cancer  great  emphasis,  with  illustrations 
on  the  screen,  has  been  laid  upon  the  urgent 
necessity  of  very  early  surgical  treatment, 
as  exemplified  in  cancer  in  these  localities. 
It  is  granted,  of  course,  that  the  epithelioma 
in  these  situations  can  often  be  completely 
extirpated,  as  it  is  primarily  a  local  de- 
rangement of  superficial  cells.  If  taken 
very  early,  therefore,  a  permanent  cure 
may  be  made,  often  with  disfiguring  scars ; 
but  the  same  can  be  accomplished  by  other 
means  with  much  less  deformity,  if  any. 
It  is,  therefore,  quite  unfair  to  use  this  as 
an  argument  for  the  surgical  treatment  of 
real  carcinoma,  which  metastasizes  and 
commonly  recurs,  locally  or  elsewhere,  with 
lethal  results. 

Turning  now  to  the  true  pathology,  in- 
cluding pathogenesis,  of  cancer  in  general, 
we  will  consider, 


198  MEDICAL  ASPECTS  OF  CANCEE 

1.  Its  nosological  relations : 

While  cancer  is  so  commonh^  regarded  as 
a  surgical  disease  and  is  generally  referred 
to  the  surgeon  for  excision,  we  have  al- 
ready seen,  and  I  hope  to  show  more  defi- 
nitely later,  that  it  is  trnly  a  constitutional 
affection,  with  the  local  lesion  as  a  product 
of  the  same,  quite  as  are  the  local  lesions 
of  gout,  syphilis,  tuberculosis,  arthritis  de- 
formans, rickets,  etc.  It  is  interesting  to 
note  that  over  a  quarter  of  a  century  ago 
the  founders  of  the  Index  Medicus  placed 
cancer  among  the  diseases  of  metabolism, 
along  with  gout,  obesity,  chronic  rheuma- 
tism, diabetes,  and  a  few  conditions  of 
minor  importance,  and  to  the  present  day 
it  is  so  ranked.  All  along  during  the  past 
one  hundred  years  many  surgeons,  recog- 
nizing the  inadequacy  of  the  knife  to  per- 
manently eradicate  cancer,  have  spoken  in 
no  uncertain  language  regarding  the  medi- 
cal relations  of  the  disease  and  its  depend- 
ence upon  diet,  mode  of  life,  etc.,  etc. 

Lambe,    over   one   hundred   years    ago, 


PATHOLOGY  OF  CANCER      199 

wrote  clearly  in  regard  to  the  causation  of 
cancer  from  luxurious  living.  He  also  ad- 
duced strong  proof  to  show  the  effect  of 
diet  in  curing  certain  cases  of  undoubted 
cancer  of  the  breast  and  uterus,  the  diag- 
nosis of  which  was  confirmed  by  prominent 
surgeons  of  the  day,  several  of  whom  en- 
dorsed the  vegetarian  diet. 

Abernethy  soon  after  wrote  pointedly  re- 
garding the  constitutional  origin  of  tumors 
and  says:  '^ There  can  be  no  subject,  I 
think,  more  likely  to  interest  the  mind  of 
the  surgeon  than  that  of  an  endeavor  to 
amend  and  alter  the  state  of  a  cancerous 
constitution.  The  best  timed  and  best  con- 
ducted operation  brings  with  it  nothing  but 
disgrace,  if  the  diseased  propensities  of  the 
constitution  are  active  and  powerful.  It  is 
after  an  operation  that,  in  my  opinion,  we 
are  most  particularly  incited  to  regulate 
the  constitution,  lest  the  disease  should  be 
revived  or  renewed  by  its  disturbance.*' 

Not  to  weary  you  unnecessarily  with  quo- 
tations from  the  many  surgeons  and  others 


200  MEDICAL  ASPECTS  OF  CANCER 

who  have  recognized  and  published  their 
belief  in  this  view  of  cancer,  I  will  merely 
mention  some  of  the  names  of  those  I  have 
quoted  in  my  books,  Walshe,  Willard 
Parker,  Sir  Astley  Cooper,  Sir  James 
Paget,  Merriam,  Venus  and  Isenberg, 
Haig,  John  Murphy,  and  William  Mayo. 

We  have  thus  seen  that  nosologically 
cancer  belongs  rightly  to  the  medical  rath- 
er than  the  surgical  branch  of  the  profes- 
sion. 

2.  Its  ethnological  and  geographical  dis- 
tribution : 

Cancer  exists  all  over  the  world,  but  in 
varying  degrees,  and,  as  we  shall  presently 
see,  modern  civilization  has  had  very  much 
to  do  with  its  prevalence  and  mortality  in 
different  regions.  The  disease  seems  to  be 
relatively  less  frequent  among  the  dark 
skinned  races  than  among  the  white,  and 
is  exceedingly  rare  among  aborigines. 

3.  The  progress  of  civilization  in  disturb- 
ing the  normal  course  of  human  life : 

Time  does  not  permit  even  a  brief  state- 


PATHOLOGY  OF  CANCER      201 

ment  of  the  recorded  facts  which  I  have 
quoted  elsewhere  in  proof  of  the  profound 
influence  of  civilization  in  the  increase  of 
cancer.  One  investigator  of  statistics  has 
remarked  that  ''the  mortality  from  cancer 
is  in  a  direct  ratio  to  the  intensity  of  hu- 
man civilization. "  It  is  to  be  remembered 
that  the  advance  of  so-called  modern  civili- 
zation, including  the  facilities  of  transpor- 
tation and  cold  storage  have  brought  from 
far  and  near  an  innumerable  number  and 
variety  of  articles  for  food  and  drink,  in- 
cluding condiments,  which  bear  no  relation 
to  the  few  simple  articles  formerly  con- 
sumed. In  the  combination  and  prepara- 
tion of  articles  of  food  also,  so-called  civili- 
zation and  refinement  have  devitalized 
many  foods  and  have  made  the  greatest  de- 
parture from  the  simple  life  of  the  abo- 
rigines, who  are  free  from  cancer.  More- 
over, with  the  increasing  ease  and  wealth 
more  and  more  individuals  of  all  classes 
are  sharing  unnecessary  and  often  harmful 
indulgences,  more  and  more  freely.     The 


202  MEDICAL  ASPECTS  OF  CANCER 

hurry  and  etrain  of  modern  life,  with 
its  prodig-jons  nervous  adivity  also  aid 
greatly  in  disturbing  normal  metabolism, 
upon  which  depends  the  maintenance  of 
health,  as  well  as  acting  directly  on  the 
vitality  of  tissue  cells. 

4.  The  changes  in  diet  and  nutrition 
which  lead  up  to  the  various  derangements 
of  the  system,  involving  the  growth  of 
healthy  and  diseased  tissues,  including 
tumors. 

That  the  diet  of  highly  civilized  commu- 
nities has  changed  immensely  during  the 
last  fifty  years,  since  cancer  has  been  on 
the  steady  increase,  there  is  no  doubt.  Lux- 
ury and  indulgence  have  taken  the  place 
of  simplicity  and  hard  work,  even  among 
the  poorer  classes,  and  it  has  been  abun- 
dantly shown  that  cancer  is  much  more 
frequent  relatively  among  the  rich  and  idle 
classes  than  among  the  poor.  This  mat- 
ter of  diet  and  nutrition  is  a  large  subject 
which  cannot  be  dwelt  on  here,  and  I  must 
refer  to  data  which  I  have  presented  else- 


PATHOLOGY  OF  CAXCER      203 

where,  which  show  plainly  that  overindul- 
gence in  animal  proteids,  coffee,  and  alco- 
hol leads  to  the  development  of  the  cancer- 
ous tendency. 

5.  The  hiochemistry  of  the  system,  ivith 
the  blood  changes  which  precede  and  ac- 
company cancer.  This  is  also  a  large  sub- 
ject which  I  have  tried  to  develop  else- 
where, and  which  can  be  here  only  lightly 
touched  upon. 

If  we  believe  that  all  growth,  both  nor- 
mal and  malignant,  depends  upon  the  car- 
rying on  of  a  proper  metabolism  in  the 
body,  the  biochemistry  of  the  system  is  of 
the  utmost  importance  in  connection  with 
cancer.  Unfortunately  this  has  been  stud- 
ied but  little  along  certain  lines,  especially 
in  what  may  be  called  the  precancerous 
stage  of  the  disease.  All  experience  has 
shown  that  cancer  has  certain  relations  to 
conditions  which  are  associated  with  faulty 
metabolism,  such  as  obesity,  gout,  diabetes, 
etc.,  and  a  careful  study  of  cancer  cases, 
both  in  their  early  and  later  stages,  dem- 


204  MEDICAL  ASPECTS  OF  CANCER 

onstrates  that  derangements  in  the  urinary 
and  intestinal  secretions  are  constantly 
present,  which  indicate  a  faulty  perform- 
ance of  the  organs  concerned  in  nutrition, 
including  the  endocrinous  glands. 

The  blood  in  cancer  has  been  studied 
mainly  in  reference  to  its  cellular  elements, 
and  many  very  well  defined  changes  have 
been  observed,  as  I  have  repeatedly  veri- 
fied. But  very  little  has  been  done  in  re- 
gard to  its  plasma,  which  latter  is  of  most 
vital  importance.  For  it  is  to  be  remem- 
bered that  the  blood  corpuscles  themselves 
are  formed  from  the  plasma,  which  receives 
not  only  the  nutritive  material  absorbed 
from  the  alimentary  tract  by  the  venous 
radicles,  but  also  the  chyle,  representing 
both  alimentary  products  and  those  ob- 
tained from  the  tissues  by  catabolism. 

There  is  great  need  of  laboratory  studies 
along  these  lines,  and  also  on  the  alkales- 
cence of  the  blood,  which  is  found  to  have 
marked  diminution  in  advancing  cancer. 


PATHOLOGY  OF  CANCEE      205 

6.  The  share  of  the  lymphatic  system  in 
the  disease. 

This  is  well  recognized  clinically  and 
pathologically  in  connection  with  metasta- 
sis, but  just  what  element  of  the  cancer- 
ous tissue  is  transported  or  how  the  sys- 
tem is  finally  affected  so  as  to  produce 
general  carcinosis,  has  not  been  fully  dem- 
onstrated. Pathology  has  not  thus  far 
helped  us  as  to  the  cure  of  cancer  in  this 
any  more  than  in  other  lines  mentioned. 

7.  The  errors  of  metabolism  leading  to 
cancer,  as  shown  by  derangements  of  the 
secretions  and  excretions  of  the  endocrin- 
ous or  ductless,  and  salivary  glands,  kid- 
neys, intestines,  etc. 

Many  of  these  errors  actually  observed 
I  have  called  attention  to  in  my  various 
writings  and  time  will  hardly  allow  more 
than  a  brief  mention  of  them.  Almost 
invariably  there  will  be  found  a  history  of 
chronic  constipation  in  patients  with  in- 
cipient and  advancing  cancer,  long  before 
the   use   of  morphine,  which,   of   course, 


206  MEDICAL  ASPECTS  OF  CANCER 

aggravates  the  condition.  Thus  the  auto- 
intoxication produced  by  the  millions  of 
micro-organisms  generated  through  intes- 
tinal stasis  and  fecal  putrification  are  a 
real  and  efficient  element  in  the  production 
of  cancer. 

Most  careful  volumetric  analysis  of  the 
urine  will  almost  certainly  show  more  or 
less  gross  deviation  from  the  normal 
standards  of  health  in  these  patients. 
This  is  not  in  the  way  of  albumen  or 
sugar  but  along  biochemical  lines,  relat- 
ing especially  to  the  partition  of  nitrogen 
and  sulphur.  The  urine  of  these  subjects 
seldom  exhibits  the  normal  amount  of  ex- 
cretion of  solid  elements  called  for  by  the 
weight  of  patients,  as  I  have  observed  in 
cases  where  the  total  daily  quantity  has 
been  measured  for  months,  and  careiull; 
analyzed  weekly:  often  it  is  not  over  one- 
half  the  correct  amount.  As  the  cancer- 
ous mass  improves  under  appropriate  di- 
etary and  medical  treatment  these  errors 
disappear. 


PATHOLOGY  OF  CANCER      207 

The  salivary  secretion  is  almost  always 
very  acid,  early  and  late  in  the  disease, 
as  shown  by  careful  testing  before  and 
after  eating  in  any  number  of  eases;  and 
this  also  becomes  normally  alkaline  or 
neutral  in  the  progress  of  treatment,  with 
proper  diet  and  prolonged  mastication,  or 
Fletcherism,  combined  with  ]3roper  medi- 
cation for  the  cancer. 

The  errors  of  excretion  of  the  ductless 
glands  and  their  relation  to  cancer  is  a 
more  difficult  proposition  to  determine,  but 
a  number  of  observers  have  insisted  on 
it,  and  from  what  little  we  know  of  the 
influence  of  these  glands  on  metabolism 
and  health  there  is  every  reason  to  be- 
lieve that  they  may  be  of  importance  in 
this  connection.  The  benefit  often  seen 
from  the  administration  of  thyroid  extract 
in  certain  cases  of  cancer  would  certainly 
look  this  way. 

We  see  thus  that  a  study  of  the  true 
pathology  of  cancer  is  quite  something 
more  than  the  mere  investigation  of  the 


208  MEDICAL  ASPECTS  OF  CANCER 

histology  of  the  diseased  tissue  through 
the  microscope,  or  inoculation  experiments 
on  rats  and  mice,  on  which  so  much  labor 
and  money  have  been  expended.  While 
these  are  of  a  certain  value,  by  means  of 
the  negative  results  obtained,  they  show  us 
that  to  understand  the  true  pathogenesis 
of  malignant  tumors  we  must  patiently 
study  the  individual  in  whom  the  diseased 
tissue  appears.  We  must  apply  all  pos- 
sible acumen,  observation,  and  logic,  with 
a  perspicacity  which  can  determine  the 
relation  of  cause  and  effect.  We  must 
know  perfectly  the  person  affected  in 
every  aspect,  and  by  this  knowledge  must 
so  direct  the  conditions  of  life  that,  with 
a  restored  catabolism  and  anabolism,  the 
metabolism  may  proceed  in  a  perfect  man- 
ner, and  the  body  tissues  be  formed  cor- 
rectly. I  realize  that  this  is  rather  a  dif- 
ficult and  optimistic  proposition  which  can 
by  no  means  be  always  secured ;  but  from 
long  experience  I  am  sure  that  this  is  the 
proper  line  along  which  to  study  the  pa- 


PATHOLOGY  OF  CANCEE      209 

thology  and  pathogenesis  of  cancer,  and 
that  with  it  we  can  obtain  far  better  re- 
sults than  with  the  knife. 

From  what  has  preceded  we  see  also 
that  the  study  of  pathology,  as  commonly 
thought  of,  has  taught  us  little  or  nothing 
positively  in  regard  to  the  cure  of  car- 
cinosis as  a  disease,  very  prone  to  recur; 
and  all  recognize  that  its  only  therapeuti- 
cal suggestion  is  to  attempt  the  removal, 
by  surgery,  the  ^r-ray,  or  radium,  of  the 
offending  mass,  which  is  only  the  product 
of  a  long  preceding  systemic  derange- 
ment, without  any  attempt  to  meet  or 
remove  the  underlying  cause.  As  well 
might  one  attempt  to  remove  surgically 
the  local  lesions  of  tuberculosis,  syphilis, 
gout,  arthritis  deformans,  or  rachitis,  with 
expectation  of  permanent  relief! 

The  theory  of  Cohnheim  in  regard  to 
the  suppositious  ''embryonic  rests''  as 
the  cause  of  the  local  lesions  of  cancer  has 
unfortunately  afforded  much  support  to 
its   surgical  treatment,  as   a  local  affec- 


210  MEDICAL  ASPECTS  OF  CANCER 

tion;  but  later  studies  have  failed  to  sus- 
tain this  claim,  which  by  no  means  an- 
swers all  the  requirements  as  to  the  pa- 
thology of  the  disease. 

We  have,  therefore,  by  exclusion  to  fall 
back  upon  the  constitutional  nature  of  the 
disease,  as  has  been  foreshadowed  by  so 
many  eminent  medical  men,  including  sur- 
geons, during  the  last  hundred  years  and 
even  up  to  the  present  time,  as  previously 
indicated.  This  line  of  investigation  has 
as  yet  had  relatively  little  attention  paid 
to  it,  and  is  the  pathology  of  the  future. 
It  behooves  the  medical  man  to  realize 
that  cancer  does  not  necessarily  belong 
to  the  surgeon,  but  that  there  is  a  vast 
field  of  clinical  and  chemical  laboratory 
research,  which  looks  forward  with  bright 
hopes  to  a  gradual  control  of  the  cancer 
scourge,  even  as  medical  wisdom  has 
brought  about  a  gradual  but  brilliant  con- 
trol of  tuberculosis. 


CHAPTER  XI 


The  glamor  of  surgery  has,  during  the 
last  two  decades,  quite  excluded  from  the 
minds  of  the  medical  profession  and  laity 
much  thought  of  the  medical  treatment  of 
cancer.  Under  previous  medical  care 
these  cases  had  commonly  been  seen  to  go 
from  bad  to  worse,  with  a  considerable 
mortality,  until  the  disease  was  considered 
incurable,  and  of  late  the  belief  has  been 
that  the  only  hope  is  offered  by  surgical 
removal.  Then  the  immediate  result  of 
well-conducted  operations  often  seemed 
favorable  for  a  time  at  least,  with  the 
possible  expectation  that  with  a  recurrence 
of  the  malady  there  was  still  hope  that 


*  Address  before  ttie  Third  District  Brancli  of  the 
New  York  State  Medical  Society,  May  3,  1918,  and 
the  Chittenden  County  (Vermont)  Medical  Society, 
May  8,  1918. 

211 


212  MEDICAL  ASPECTS  OF  CANCER 

further  operations  might  succeed  in  erad- 
icating the  disease;  and  for  the  last  two 
decades  surgery  has  had  full  sway. 

But,  alas,  both  the  medical  profession 
and  the  laity  have  been  blind  to  the  steady 
and  really  alarming  increase  in  the  mor- 
tality from  cancer  since  1900,  as  shown 
by  the  statistics  published  by  the  United 
States  Government.  In  the  year  1900  the 
mortality  from  cancer  was  63  per  100,000 
population,  and  in  1916  it  had  risen  to 
81.8,  or  18.8  more  persons  dying  from 
the  disease  in  each  100,000,  an  increase  in 
the  death  rate  of  29.84  per  cent. !  During 
this  same  period  the  mortality  from  tu- 
berculosis has  fallen  from  201.9  to  141.6 
persons  in  each  100,000;  a  decrease  of 
60.3  persons,  or  29.86  per  cent.,  under 
careful  medical  treatment! 

There  could  hardly  be  a  more  eloquent 
argument  than  this  for  the  application  of 
medical  acumen  to  the  study  and  treat- 
ment of  cancer.  It  must  be  remembered 
that  the  results  in  tuberculosis  have  not 


MEDICAL  TREATMENT        213 

been  attained  through  the  application  of 
any  one  specific  remedy,  for  tuberculin 
has  played  but  a  small  and  uncertain  part 
in  the  improvement  of  its  vital  statistics, 
which  have  been  secured  mainly  through 
nutritional  lines  of  treatment. 

In  the  same  manner,  after  the  enormous 
amount  of  laboratory,  experimental  and 
clinical  work  done  in  cancer,  which  has 
yielded  only  negative  results,  we  cannot 
expect  to  find  any  specific  remedy  for 
cancer,  such  as  mercury  is  for  syphilis, 
quinine  for  malaria,  antitoxin  for  diph- 
theria, etc.,  and  we  must  search  for  its 
true  pathology  and  treatment  along  med- 
ical lines:  for  now  it  is  recognized  on  all 
sides  that  the  knife  does  not  cure  can- 
cer, but  only  removes  some  of  the  prod- 
ucts of  disease. 

Unfortunately  the  historical  path  of 
cancer  is  strewn  with  the  wrecks  of 
blasted  hopes  regarding  various  remedies, 
quack  and  other,  whose  virtues  for  the 
cure  of  the  disease  have  been  heralded 


214  MEDICAL  ASPECTS  OF  CANCER 

for  a  while,  only  to  sink  in  oblivion,  to 
the  sad  disappointment  of  trusting  suf- 
ferers from  this  dire  malady.  Various 
serums  have  been  tried,  with  varying  suc- 
cess in  certain  cases  for  a  while,  but  these 
too  have  gone  the  way  of  the  others.  The 
reason  of  this  is  plain,  because  from  the 
real  nature  of  cancer  they  could  not  be 
expected  to  alter  permanently  the  consti- 
tutional conditions  occasioning  the  malig- 
nant growth.  The  x-yslj  and  radium  do 
seem  to  have  considerable  power  in  alter- 
ing and  often  removing  morbid  tissue, 
when  it  is  accessible;  but,  of  course,  they 
cannot  reach  the  underlying  cause,  which 
produces  and  reproduces  the  same  lesions, 
any  more  than  can  surgery. 

We  are  therefore  thrown  back  upon 
seeking  to  discover  what  is  this  underly- 
ing cause  of  malignant  new  growth,  and 
determining  what  measures  can  be  em- 
ployed to  so  alter  the  system  that  this 
departure  from  normal  nutrition  shall  not 
occur.     For  it  is  acknowledged  by  all  that 


MEDICAL  TEEATMENT        215 

cancer  represents  only  a  deviation  from 
the  normal  life  and  action  of  certain  or- 
dinary cells  of  the  body,  which  were  once 
healthy,  but  which  for  some  reason,  diffi- 
cult to  understand,  take  on  an  abnormal 
or  morbid  action:  with  this  there  is  a 
continued  tendency  in  them  to  a  malig- 
nancy which  invades  contiguous  tissue,  as- 
sociated with  a  pernicious  anemia  which 
in  the  end  tends  to  destroy  life. 

It  would  lead  us  far  beyond  the  pro- 
posed limits  of  this  paper  to  attempt  to 
at  all  study  the  underlying  causes  of  can- 
cer, which  have  been  pretty  well  consid- 
ered elsewhere.  But  in  order  to  fuUy 
understand  what  is  to  follow  brief  men- 
tion may  be  made,  somewhat  dogmati- 
cally, perhaps,  of  the  grounds  upon  which 
the  medical  treatment  of  the  disease  is 
justified  and  is  to  be  based. 

First  we  may  very  briefly  examine  the 
claims  that  cancer  is  a  wholly  local  dis- 
ease, which  may  be  eradicated  by  surgery, 
if  taken  early  enough. 


216  MEDICAL  ASPECTS  OF  CANCER 

In  most  if  not  all  surgical  writings  can- 
cer is  regarded,  primarily  at  least,  as  a 
purely  local  affection,  and  the  subject  of 
a  possible  constitutional  cause  and  the 
reason  of  its  continued  malignancy  are 
seldom  even  alluded  to. 

Cohnheim  suggested  that  the  origin  of 
cancer  was  in  what  he  called  ''embryonic 
rests,"  or  wrongly  placed  prenatal  epi- 
thelial tissue  elements.  This  theory  is 
more  fanciful  than  satisfying  or  demon- 
strable, and  it  is  difficult  to  understand 
why  such  "embryonic  rests,"  after  re- 
maining so  long  quiescent,  should  suddenly 
take  on  such  malignant  and  destructive 
action;  unless  the  blood  stream  has  become 
so  altered  as  to  furnish  a  proper  pabulum 
for  their  rampant  growth. 

Ribert  later  developed  a  somewhat  simi- 
lar hypothesis,  but  neither  of  these  theories 
have  been  substantiated  by  others,  and  no 
one  has  ever  seen  cancer  develop  from  such 
cells;  although  it  is  granted  that  the  local 
lesion  of  carcinoma  must  start  in  some  par- 


MEDICAL  TEEATMENT        217 

ticular  cell  or  cells  which  take  on  morbid 
action. 

Failing  to  find  an  idiopathic  local  cause 
for  the  origin  of  malignant  tumors,  re- 
course was  had  to  a  parasitic  theory,  and 
the  most  diligent  search  has  been  carried 
on  by  innumerable  observers  to  discover 
the  parasite.  But  as  one  micro-organism 
after  another  has  been  proclaimed,  its  eti- 
ological relation  has  been  disproved  by 
other  observers,  and  now  few  scientists 
believe  that  cancer  is  caused  by  a  living 
parasite.  Many  of  these  latter  are  cer- 
tainly found  on  ulcerated  lesions  and  un- 
doubtedly contribute  to  the  later  destruc- 
tive process,  but  none  have  ever  been  dem- 
onsl^rated  to  cause  such  a  new  growth,  in 
spite  of  most  faithful  experimentation. 
The  fact  that  surgeons,  nurses,  or  pathol- 
ogists never  acquire  the  disease  from  con- 
tact is  pretty  conclusive  evidence  that  no 
such  parasitic  cause  exists,  for  cancer  is 
certainly  not  contagious  or  even  inocula- 
ble. 


218  MEDICAL  ASPECTS  OF  CANCER 

Still  contending  for  a  local  etiology  of 
cancer  very  many  have  insisted  upon  lo- 
cal irritation  as  the  efficient  cause  for  its 
occurrence.  The  arguments  and  illustra- 
tions for  this  are  indeed  strong,  but  when 
carefully  analyzed  they  are  found  quite 
insufficient  to  account  for  the  real  nature 
of  the  trouble;  although  it  must  be  ac- 
cepted that  in  many  instances  it  acts  as 
the  exciting  cause  of  the  special  local  le- 
sion. Thus,  few  can  question  that  cancer 
of  the  lower  lip  may  be  excited  by  pipe 
smoking,  cancer  of  the  mouth  by  decayed 
and  irritating  teeth  and  betel  chewing, 
etc.  Many  claim  that  cancer  of  the  breast 
is  the  result  of  a  blow  or  pressure,  cancer 
of  the  uterus  from  laceration  of  the  cer- 
vix, cancer  of  the  stomach  from  a  peptic 
ulcer,  etc.  But  for  the  numerous  in- 
stances of  internal  cancer,  as  of  the  kid- 
ney, bladder,  brain,  etc.,  no  such  cause  can 
be  predicated. 

Moreover,  when  we  really  study  the  mat- 
ter, and  consider  how  relatively  few  cases 


MEDICAL  TEEATMENT        219 

of  cancer  of  the  lip  occur  in  smokers,  how 
almost  every  woman  at  some  time  may 
have  a  blow  on  the  breast,  how  few  cases 
of  cancer  of  the  mouth  develop  in  those 
with  bad  teeth,  etc.,  we  readily  see  that 
there  must  be  some  other  element  than  the 
local  irritant  to  induce  a  true  cancer, 
which  causes  a  local  lesion  to  run  such  a 
malignant,  persistent,  and  fatal  course.  It 
is  quite  as  reasonable  to  ascribe  a  syphi- 
litic gumma,  or  a  tubercular  joint,  or  a 
gouty  toe  to  local  injury,  although  that 
may  have  been  the  immediate  exciting 
cause  of  the  disease  in  some  particular 
locality. 

Heredity  has  been  blamed  for  the  ad- 
vent of  malignant  disease,  but  statistics  of 
Life  Insurance  Companies  show  the  con- 
trary, and  a  careful,  recorded,  clinical 
study  of  intelligent  private  patients  with 
cancer  fails  to  show  any  greater  percent- 
age of  ancestral  occurrence  than  is  ac- 
counted for  on  natural  grounds.  Thus, 
every  one  has  many  ancestors  and  near 


220  MEDICAL  ASPECTS  OF  CANCER 

relatives,  some  of  whom  may  have  devel- 
oped the  disease  from  the  same  causes, 
which  will  be  considered  later.  The  very- 
rare  instances  of  ^* cancer  families''  which 
have  been  recorded  may  be  easily  ex- 
plained in  this  way;  namely,  that  the  per- 
sons probably  lived  the  same  kind  of  life, 
and  were  subjected  to  the  same  systemic 
disturbances  as  those  which  produced  can- 
cer in  the  person  under  consideration. 

In  the  absence  of  local  or  hereditary 
causes  for  cancer,  we  are  forced  to  the 
belief  that  there  is  some  constitutional  or 
systemic  change  in  the  composition  of  the 
nutrient  fluids  of  the  body  which  causes 
certain  cells  or  portions  to  take  on  such 
a  morbid  change.  There  is  no  more  dif- 
ficulty in  understanding  the  local  phenom- 
ena of  cancer  than  there  is  in  understand- 
ing why  other  diseases  seize  upon  special 
localities.  Thus,  in  gout  the  great  toe  is 
commonly  affected,  or  the  tendo  Achillis, 
etc.,  a  Syphilitic  new  growth  may  occur 
in  various  sites,  even  in  the  brain  or  ar- 


MEDICAL  TREATMENT        221 

teries,  a  tubercular  lesion  may  develop 
here  or  there  without  any  known  cause, 
etc.  What  the  first  changes  are,  and  why 
they  occur,  will  probably  always  be  a  mys- 
tery. 

It  would  carry  us  too  far  away  from 
our  immediate  subject  to  attempt  to  con- 
sider fully  the  pathological  changes  which 
go  on  in  normal  cell  life  as  compared  with 
those  observed  in  cancer  tissue,  but  a 
brief  mention  of  some  important  points 
can  be  made  with  advantage. 

Karyokinesis,  mitosis,  or  indirect  cell 
division,  is  at  the  bottom  of  all  growth, 
both  normal  and  malignant,  and  the  two 
classes  of  growth  differ  only  in  their 
methods  and  activity. 

In  normal  tissue  growth  and  reproduc- 
tion the  nucleus  with  its  chromosomes  and 
the  cent ro  some  divide  equally,  one  half 
going  to  each  new  cell,  into  which  the 
mother  cell  divides,  the  centrosome  being 
the  dynamic  or  controlling  center  for  the 
reproductive  activity  of  the  cell. 


222  MEDICAL  ASPECTS  OF  CANCER 

In  healthy  tissue  this  cell  proliferation 
proceeds  in  an  orderly  manner,  forming 
normal,  homologous  structures :  in  the  case 
of  the  skin,  hair,  and  nails  these  are  re- 
moved mechanically.  In  internal  struc- 
tures, while  new  cells  of  homologous  na- 
ture are  thus  reproduced  by  anabolism, 
the  older  and  effete  cells  are  removed  by 
catabolism,  the  two  processes  together  con- 
stituting metabolism.  The  elements  of 
which  these  effete  cells  are  composed  are 
split  up  into  their  component  parts  and 
carried  off  by  the  blood  or  lymph  stream, 
and  either  discharged  as  effete  substances 
or  re-utilized  in  the  system  along  physio- 
logical lines. 

In  morbid  or  malignant  growth  of  epi- 
thelial or  gland  cells,  constituting  cancer, 
there  seems  to  be  some  error  in  the  di- 
vision of  the  elements  of  the  cell,  and  the 
centrosome  or  controlling  center  of  repro- 
duction is  lost  or  deranged  in  the  offend- 
ing cell  or  cells,  which  then  proceed  on 
their    untoward    course    of    destruction. 


MEDICAL  TREATMENT        223 

These  multiply  more  or  less  rapidly  and 
form  a  mass  of  heterologous  tissue,  inca- 
pable of  being  utilized  in  the  system,  in- 
vading contiguous  tissues  and  tending  to 
ulceration.  Whether  this  original  error 
in  mitosis  is  caused  by  irritation,  physical 
or  chemical,  or  from  loss  of  nervous  con- 
trol cannot  be  told.  There  seems  to  be 
some  reason  to  support  the  view  advo- 
cated by  Williams,  namely,  that  tumor 
formation  and  growth  are  but  forms  of 
agamogenesis,  or  non-sexual  production  of 
cells,  distinctly  related  to  the  decline  in 
growth  of  the  body  in  general.  Hence 
while  the  forces  of  growth,  development, 
and  reproduction  are  in  greatest  activity 
in  early  life  the  tendency  to  this  disease 
is  relatively  small:  but  when  growth  de- 
clines and  nutrition  is  relatively  slow  the 
cells  undergo  gemmation,  owing  to  per- 
verted nutriment,  and  thus  hyperplasia 
and  not  inflammation  is  the  starting-point 
of  every  neoplasm.  The  interesting 
thought  in  regard  to  this  curious  tendency 


224  MEDICAL  ASPECTS  OF  CANCER 

to  cell  misbehavior  is  that  it  is  sometimes 
spontaneously  arrested,  and  can  also  be 
overcome  by  proper  constitutional  meas- 
ures, as  many  testify. 

To  understand  rightly  how  this  can  be 
accomplished  we  must  very  briefly  con- 
sider some  of  the  constitutional  conditions 
observed  in  patients  with  cancer,  even  in 
early  stages  of  the  disease,  and  with  in- 
creasing severity  as  it  advances. 

It  may  first  be  remarked  that  patients 
developing  cancer  often  seem  to  be  in  such 
perfect  health,  even  with  ruddy  complex- 
ion, that  it  is  hard  to  convince  them  that 
the  local  lesion,  suspected  or  discovered, 
can  possibly  be  of  the  very  serious  na- 
ture which  later  developments  prove. 

As  in  surgery  it  is  so  strongly  claimed 
that  the  very  early  recognition  of  cancer, 
and  early  operative  interference  are  most 
important,  so  especially  in  regard  to  its 
medical  treatment  the  best  results  are  ob- 
tained when  the  disease  is  recognized  early 
and  proper  dietary  and  medicinal  treat- 


MEDICAL  TREATMENT        225 

ment  are  rigidly  enforced,  as  experience 
abundantly  shows.  However,  during  all 
the  course  of  cancer,  even  to  the  end,  the 
benefits  of  strict  medical  supervision  are 
often  surprisingly  manifest.  Every  effort, 
therefore,  should  be  made  to  establish  the 
diagnosis  early,  and  every  endeavor 
should  be  maintained  to  see  that  each  de- 
tail of  treatment  is  carried  out  with  ab- 
solute fidelity,  even  long  after  the  original 
lesion  has  disappeared.  Otherwise  any 
laxness  and  return  to  the  same  conditions 
of  life  which  caused  the  first  new  for- 
mation to  develop  can  reproduce  the  dis- 
ease in  the  original  site  or  elsewhere. 

To  understand  rightly  the  constitutional 
nature  of  cancer  and  the  reasonableness 
of  a  medical  treatment,  brief  reference 
must  be  made  to  some  of  the  systemic 
conditions  which  have  been  established  ex- 
perimentally by  the  laboratory,  and  by 
clinical  experience. 

The  blood  has  long  been  recognized  as 
a  factor  of  importance  in  connection  with 


226  MEDICAL  ASPECTS  OF  CANCER 

cancer,  as  is  clinically  manifested  by  the 
intense  cachexia  and  anaemia  commonly 
present  and  always  strongly  marked 
toward  the  end.  Many  studies  have  been 
made  on  the  cytology  of  the  blood  in  these 
cases,  all  confirming  many  radical  changes 
in  its  solid  elements,  as  I  have  constantly 
observed.  Unfortunately  there  have  been 
relatively  few  studies  of  the  plasma  of  the 
blood,  whereas  it  is  from  the  plasma  that 
the  blood  corpuscles  are  formed,  and  that 
is  the  principal  agent  in  the  development 
And  nutrition  of  tissues,  normal  and  ma- 
lignant. For  it  is  to  be  remembered  that 
the  chyle,  conveying  products  of  diges- 
tion, is  discharged  by  the  lymphatics  di- 
rectly into  the  venous  blood  current,  and 
the  venous  radicles  also  absorb  much  of 
the  nutritive  material  directly  from  the 
abdominal  organs.  The  plasma,  there- 
fore, carries  with  it  a  varying  quantity  of 
partially  assimilated  material,  to  be  ox- 
idized in  the  lungs  and  slowly  purified  by 
the  agency  of  the  kidneys.     There  is  great 


MEDICAL  TREATMENT        227 

need  of  laboratory  studies  along  these 
lines,  and  also  on  the  alkalescence  of  the 
blood,  which  has  been  found  to  have  a 
marked  diminution  in  cancer. 

The  urine,  reflecting  the  character  of  the 
arterial  blood,  has  been  extensively  stud- 
ied in  cancer,  and  my  innumerable  volu- 
metric analyses  more  than  confirm  all  that 
has  been  observed.  In  some  cases  I  have 
had  the  daily  output  of  the  urine  saved 
and  measured  for  weeks  and  months,  and 
in  some  instances  for  over  a  year,  often 
with  complete  volumetric  analysis  each 
week  or  two :  and  rarely  is  it  found  to  be 
that  of  health.  This  does  not  refer  to 
albumen  or  casts,  or  sugar,  but  in  regard 
to  its  measured  acidity,  its  mineral  con- 
tents, urea,  indican,  etc.  As  an  indicator 
of  the  manner  in  which  metabolism  is 
carried  on,  it  is  of  the  very  greatest  im- 
portance. Almost  invariably  the  total 
amount  of  solids,  excreted  by  the  kidneys 
is  found  to  be  deficient  in  relation  to  the 
weight  of  the  individual :  this  is  constantly 


228  MEDICAL  ASPECTS  OF  CANCER 

observed  even  in  the  very  early  stages 
of  cancer.  The  output  of  urea  is  almost 
invariably  diminished,  often  very  greatly, 
as  I  have  verified  time  and  again  in  many 
cases. 

The  nitrogen  partition  has  been  found 
to  be  at  fault  by  many  observers,  as  also 
that  of  sulphur,  the  details  of  which  have 
been  elsewhere  presented,  with  a  great  in- 
crease of  neutral  (unoxidized)  sulphur, 
with  indican,  showing  intestinal  fermenta- 
tion, as  I  have  constantly  observed.  All 
this  indicates  errors  in  protein  metabo- 
lism. 

Imperfect  intestinal  excretion  and  con- 
stipation are  almost  invariably  found  in 
the  subjects  of  cancer,  even  in  its  earliest 
stages,  and  long  before,  so  that  auto-tox- 
aemia from  intestinal  fecal  absorption  and 
the  products  of  microbic  action  must  be 
looked  upon  as  one  of  the  elements  of 
blood  derangement  which  favors  the  de- 
velopment of  malignant  tissue. 

The  saliva  is  almost  invariably  found 


MEDICAL  TREATMENT        229 

to  be  acid,  even  in  early  cancer,  instead 
of  alkaline  or  neutral,  as  I  have  noted  in 
hundreds  of  testings  made  before  and 
after  eating  in  patients  in  the  New  York 
Skin  and  Cancer  Hospital  and  in  my  of- 
fice. As  dietary  and  other  treatment  with 
proper  mastication  is  carried  on  rightly, 
with  improvement  in  the  general  condition 
and  in  the  cancer  mass,  the  saliva  returns 
to  its  normal  alkalinity,  but  with  a  ten- 
dency to  relapse  into  an  acid  condition.  I 
think  I  have  never  failed  to  find  it  acid 
in  cancer  of  the  deeper  oral  region. 

It  is  interesting  in  this  connection  to 
recall  that  Mayo  has  remarked  that  cancer 
is  apt  to  develop  in  regions  exhibiting  an 
acid  reaction.  Thus,  while  it  is  common 
in  the  stomach  it  is  absent  in  the  alkaline 
duodenum,  and  again  common  in  the  acid 
colon;  it  is  also  frequent  in  the  bladder 
under  acid  conditions. 

Time  does  not  permit  of  further  elabo- 
ration of  the  constitutional  relations  of 
cancer,  such  as  the  relation  of  the  ductless 


230  MEDICAL  ASPECTS  OF  CANCER 

glands  to  the  disease,  which  has  received 
considerable  attention.  But  from  the  ben- 
efit which  has  been  observed  from  the  ad- 
ministration of  thyroid  extract  and  per- 
haps some  other  extracts  in  certain  cases 
of  cancer,  it  would  seem  that  the  endocrin- 
ous glands,  which  have  such  an  influence 
on  metabolism,  are  factors  in  connection 
with  the  genesis  and  cure  of  cancer. 

That  diet,  good  or  bad,  has  a  great  in- 
fluence on  the  formation  and  growth  of 
tumors  there  can  be  no  doubt,  as  has 
been  shown  by  many  observers.  The  sub- 
ject is  so  large  a  one  that  it  can  hardly 
be  more  than  touched  upon  here,  but  it  is 
of  immense  importance  in  connection  with 
the  medical  treatment  of  cancer.  One 
need  only  recall  the  almost  complete  im- 
munity from  the  disease  which  has  been 
repeatedly  reported  in  aborigines  and  in 
those  living  in  countries  or  regions  where 
the  food  is  wholly  or  largely  vegetarian. 
Also  the  reported  increase  of  cancer  mor- 
tality in  proportion  to  the  steady  increase 


MEDICAL  TREATMENT        231 

in  meat  eating  in  many  comitries  and  lo- 
calities, as  I  have  shown  elsewhere.  Some 
have  also  emphasized  the  relation  of  can- 
cer to  deficient  or  deranged  supply  of  the 
mineral  substances  required  by  the  healthy 
body,  and  of  late  much  attention  has  been 
directed  to  the  relation  of  vitamines  to 
normal  and  diseased  growth. 

Not  to  dwell  too  long  upon  the  many 
evidences  of  the  constitutional  or  systemic 
relations  of  cancer,  pointing  to  deranged 
metabolism  as  its  basic  cause,  we  will  pass 
at  once  to  the  more  practical  matters  re- 
lating to  its  prophylaxis  and  treatment. 

First  we  must  dwell  very  briefly  on  the 
dietetic  relations  of  cancer  which  have 
been  well  established  by  research  labora- 
tories, statistics,  and  clinically.  The  de- 
tails and  references  relating  to  these  facts 
are  given  fully  in  the  books  already  re- 
ferred to. 

Experimentally  it  has  been  found  that 
mice  living  on  rice  cannot  be  inoculated 
with  cancer.    In  another  series  of  experi- 


232  MEDICAL  ASPECTS  OF  CANCER 

ments  75  per  cent,  of  inoculated  white 
mice  living  on  normal  laboratory  diet  ac- 
quired the  disease,  while  only  19  per  cent, 
of  those  on  a  non-protein  diet  were  af- 
fected; moreover  the  tumors  in  the  latter 
in  30  days  were  hardly  larger  than  those 
in  the  former  in  10  days. 

Statistically  it  has  been  abundantly 
shown  that  cancer  mortality  has  increased 
immensely  with  an  increase  in  the  con- 
sumption of  meat.  Thus,  in  England,  the 
amount  of  meat  eaten  per  capita  has  dou- 
bled in  the  last  50  years  and  the  cancer 
deaths  have  quadrupled.  The  same  has 
been  shown,  though  in  a  lesser  degree,  in 
Australia,  and  in  many  other  countries. 
In  the  United  States  the  mortality  from 
cancer  has  risen  almost  30  per  cent,  since 
1900,  while  our  yearly  per  capita  of  meat 
eating  has  increased  steadily  and  greatly, 
so  that  a  few  years  ago  it  was  reported 
from  Washington  to  be  the  enormous 
amount  of  172  pounds,  per  capita,  much 
more  than  in  England. 


MEDICAL  TREATMENT        233 

There  is  also  strong  statistical  evidence 
that  the  continued  increase  in  the  con- 
sumption of  coffee  and  alcohol  has  some- 
thing to  do  with  the  rising  mortality  of 
cancer.  Holland  is  shown  to  be  the  high- 
est per  capita  consumer  of  coffee  of  any- 
country  in  Europe,  and  the  cancer  death 
rate  there  in  1905  was  among  the  highest, 
while  Hungary  was  the  smallest  per  cap- 
ita consumer  of  coffee  and  the  cancer 
mortality  was  only  39  per  100,000,  or  a 
little  over  one-third  that  in  Holland.  The 
people  in  the  United  States  consume  one- 
third  of  the  total  coffee  produced,  or  more 
than  Germany,  Austria,  Hungary,  France, 
and  the  United  Kingdom  combined. 

Clinically  it  has  been  shown  by  observ- 
ers, all  over  the  world,  that  cancer  is 
practically  unknown  among  the  aborigines, 
living  simple  and  mainly  vegetarian  lives, 
while  the  same  people  rapidly  acquire  the 
disease  when  they  come  in  close  contact 
with  foreigners  and  acquire  their  habits, 
including  the  free  consumption  of  meat. 


234  MEDICAL  ASPECTS  OF  CANCER 

During  a  rather  extensive  trip  through 
the  Far  East  I  was  unable  to  see  or  even 
hear  of  any  cancer,  although  I  met  a  large 
number  of  medical  men  and  made  diligent 
inquiry  regarding  the  same.  As  I  wished 
to  verify  my  views  in  regard  to  the  rarity 
of  the  occurrence  of  cancer  among  those 
who  lived  on  rice  or  other  vegetarian  diet, 
I  visited  very  many  civil,  military  and 
missionary  hospitals,  with  a  total  of  many 
thousands  of  patients,  and  ministering  to 
many  millions  of  population.  In  Japan, 
Korea,  the  Philippines,  India,  Siam,  and 
Egypt,  I  met  the  same  response,  that  can- 
cer was  rarely  seen  among  those  vege- 
tarian natives.  From  many  years  experi- 
ence with  the  disease  in  private  and  pub- 
lic practice  I  have  so  constantly  observed 
the  remarkable  results  of  an  absolutely 
vegetarian  diet  in  controlling  cancer, 
which  results  have  been  watched  by  many 
physicians,  that  the  conviction  is  irresist- 
ible as  to  the  influence  of  diet  in  this 
dire  malady. 


MEDICAL  TREATMENT        235 

If  time  permitted  I  could  make  quota- 
tions from  a  large  number  of  prominent 
physicians  and  surgeons  who  fully  bear 
me  out  in  the  claims  here  made.  These 
statements  have  often  been  brief  but  con- 
clusive in  medical  and  surgical  writings, 
and  taken  collectively  leave  little  ground 
for  debate.  None,  however,  have  hereto- 
fore attempted  to  gather  together  all  the 
evidence  already  presented  of  the  consti- 
tutional origin  of  cancer,  and  apparently 
little  impression  has  been  made  upon  the 
medical  profession  or  the  laity  as  to  any 
other  method  of  reaching  the  disease  than 
by  the  knife.  Nor  has  there  been  any  at- 
tempt to  formulate  the  measures  which 
otfer  any  particular  hope  of  reaching  and 
remedying  the  cause  of  the  malignant 
growth.  And  yet  quite  recently  Aebli,  a 
Swiss  physician,  has  shown  very  clearly  by 
the  analysis  of  large  numbers  of  cases, 
both  of  those  who  had  been  operated  upon 
and  those  who  had  been  left  practically 
alone,  that  even  then  the  advantage  of  the 


236  MEDICAL  ASPECTS  OF  CANCER 

knife  cases  as  to  longevity,  is  negligible. 
With  a  most  careful,  intelligent,  and  con- 
tinued dietary  and  medical  treatment  it  can 
be  readily  shown  that  the  advantages  of 
such  a  method  of  overcoming  the  disease 
far  exceed  anything  which  can  be  predi- 
cated of  active  surgery. 

Moreover,  if  it  can  be  established  what 
are  the  underlying  causes  of  cancer,  and 
by  what  means  these  can  be  overcome,  we 
have  advanced  a  long  way  toward  the 
prophylaxis  of  this  dire  disease.  For  it  is 
recognized  as  certain,  and  shown  by  sta- 
tistics that  the  knife  can  never  control 
cancer,  since  after  active  propaganda  as 
to  early  operation  the  mortality  has  risen 
so  steadily  and  greatly,  that  it  is  now  ac- 
knowledged by  surgeons  that  90  per  cent, 
of  those  once  affected  die  from  its  rav- 
ages. In  the  year  following  this  active 
propagandism  the  United  States  Mortality 
Tables  show  that  the  percentage  of  deaths 
was  nearly  double  that  of  the  average  of 
the  five  preceding  years. 


MEDICAL  TEEATMENT        237 

In  regard  to  the  exact  maimer  in  which 
dietary  and  other  errors  in  life  result  in 
such  a  derangement  of  cell  activity  as  to 
produce  malignant  growth  we  are  yet  a 
good  deal  in  the  dark,  and  possibly  we 
shall  never  know.  But  all  evidence  as  to 
the  constitutional  cause  of  cancer  points 
to  metabolic  derangement,  caused  in  vari- 
ous ways,  prominent  among  which  are  di- 
etary errors,  connected  also  with  faulty 
action  of  one  or  more  of  the  different  or- 
gans of  the  body.  Undoubtedly  nervous 
shock  or  strain,  insufficient  bodily  exer- 
cise, impure  air,  imperfect  mastication, 
possibly  microbic  action  and  many  other 
elements  contribute  to  cause  such  systemic 
derangements  as  lead  up  to  the  faulty  met- 
tabolism  producing  cancer. 

The  point  to  recognize  is  that  the  blood 
current  which  nourishes  everything  has  in 
some  way  become  so  deranged,  either  in 
regard  to  its  organic  or  inorganic  con- 
stituents, that  nutrition  is  not  properly 
carried  on,  and  certain  cells  take  on  an 


238  MEDICAL  ASPECTS  OF  CANCER 

abnormal  or  morbid  action,  which  we  call 
cancer.  If  means  can  be  found,  dietary, 
hygienic,  or  medicinal,  of  restoring  a  per- 
fectly healthy  action  of  the  system,  and 
a  normal  or  relatively  perfect  blood 
stream,  the  depraved  cells  again  take  on 
healthy  action  and  even  a  retrograde  met- 
amorphosis can  take  place  in  tumors  which 
have  been  already  formed.  This  event  ex- 
perience abundantly  testifies. 

The  elements  in  the  medical  treatment 
of  cancer,  and  its  prophylaxis  have  al- 
ready been  indicated  in  what  has  preceded, 
and  little  more  need  be  said  in  closing. 
Each  and  every  case  of  cancer  is  a  study 
in  itself,  and  much  skill,  medical  acumen, 
patience,  grit,  and  perseverance  must  be 
applied  if  true  success  is  to  be  expected. 
While  in  surgery  it  is  recognized  that  the 
results  vary  greatly  mth  the  skill  of  the 
operator,  so  much  more  in  the  medical 
treatment  of  cancer  all  the  qualities  men- 
tioned are  required.  We  have  learned  the 
lesson   in   regard   to  tuberculosis,   whose 


MEDICAL  TREATMENT        239 

death  rate  has  diminished  nearly  30  per 
cent,  since  1900,  while  that  of  cancer  has 
risen  nearly  30  per  cent,  in  the  same  period 
of  time,  the  disease  tuberculosis  being 
constantly  overcome  in  spite  of  the  con- 
tinued presence  of  the  bacillus;  let  us 
learn  it  in  regard  to  cancer,  where  no 
such  microbic  cause  exists. 

As  you  will  recognize  from  what  has 
already  been  said,  diet  is  the  most  im- 
portant part  in  the  treatment  and  prophy- 
laxis of  cancer.  Without  exactly  the 
proper  diet,  rigidly  carried  out  for  a  long 
time,  and  even  indefinitely,  no  good  re- 
sults can  be  expected.  To  aid  in  carry- 
ing this  out  a  diet  card  has  been  prepared 
for  my  medical  cancer  clinic,  in  the  New 
York  Skin  and  Cancer  Hospital,  which  I 
also  use  in  private  practice.  These  can 
be  freely  obtained  by  application  to  the 
Superintendent  of  the  Hospital,  in  person 
or  by  letter. 

While  the  diet  on  this  card  has  been 
worked  out  by  our  dietitian  it  is  not  pre- 


240  MEDICAL  ASPECTS  OF  CANCER 

sented  as  perfect,  and  changes  can  un- 
doubtedly be  made  with  advantage.  The 
average  daily  ration  represents  2100  cal- 
ories, with  about  140  of  vegetable  protein, 
and  it  is  calculated  for  a  patient  of  about 
150  pounds,  in  bed  or  not  taking  active 
exercise.  The  rules  given  on  the  card  are 
to  be  accurately  followed.  This  has  been 
used  by  large  numbers  of  patients  with 
most  satisfactory  results.  Patients  in  pri- 
vate and  public  practice  are  frequently 
questioned  as  to  their  faithfulness  in  car- 
Tjiiig  out  absolutely  the  requirements  of 
the  ^* green  card.'' 

But  diet  is  not  the  only  measure  of  im- 
portance in  the  treatment  of  cancer,  al- 
though as  stated  it  is  the  first,  and  most 
important,  without  which  all  else  is  in 
vain.  Proper  internal  medication  is  al- 
ways needed,  and  that  continually  over  a 
long  period  of  time,  in  order  to  secure 
and  maintain  a  correct  metabolic  activity 
which  is  antagonistic  to  the  cancerous 
tendency.    As    previously    mentioned,    if 


MEDICAL  TREATMENT        241 

there  is  a  relapse  into  the  same  systemic 
conditions  which  produced  the  original 
malignant  tumor,  there  is  no  reason  to  ex- 
pect that  the  same  deadly  process  will  not 
repeat  itself. 

The  medicinal  treatment  of  cancer  is  a 
hard  subject  to  speak  briefly  about.  As 
already  intimated,  there  is  no  specific  for 
cancer  and  probably  never  will  be.  Each 
case  has  to  be  studied  most  carefully,  even 
week  by  week,  and  during  prolonged 
treatment  very  many  remedies  may  be  re- 
quired to  meet  various  requirements,  in 
order  to  make  the  metabolism  correct  and 
to  keep  it  so. 

To  aid  in  this  a  constant  and  careful 
study  of  the  urine  is  necessary.  This  re- 
lates to  the  total  daily  output,  securing 
an  efficient  elimination  of  solids  in  propor- 
tion to  the  body  weight,  the  actual  volu- 
metric acidity,  the  organic  and  mineral  in- 
gredients, etc.,  which  have  been  presented 
fully  in  the  volumes  referred  to.  For  this 
repeated  and  complete  volumetric  analyses 


242  MEDICAL  ASPECTS  OF  CANCER 

are  necessary.  The  iniportance  of  these 
methods  can  hardly  be  overestimated. 

Much  care  must  also  be  exercised  in  se- 
curing a  full  and  satisfactory  intestinal 
elimination,  which  is  to  be  assiduously 
cared  for  and  not  left  to  the  patient's  dis- 
cretion or  treated  in  a  routine  or  careless 
manner.  There  are  many  minor  items  in 
regard  to  the  care  of  these  patients  which 
cannot  be  entered  upon  now,  and  have 
been  treated  of  elsewhere,  but  it  can  only 
be  stated  that  attention  to  the  smallest 
details  of  life  are  essential  to  securing  the 
best  results  in  the  plan  of  treatment  under 
consideration. 

It  was  stated  a  while  ago  that  there 
was  no  specific  for  cancer  and  probably 
there  would  never  be,  but  there  is  one 
remedy  which  has  so  continually  proved 
of  inestimable  value  that  it  should  be 
mentioned.  That  is  one  of  the  salts  of 
potassium,  as  has  long  been  used  by  me, 
and  more  lately  confirmed  by  several  ob- 
servers.    This  should  never  be  neglected 


MEDICAL  TEEATMENT        243 

in  handling  these  cases,  and  may  be  ad- 
ministered over  long  periods  with  advan- 
tage, alternated  perhaps  with  various 
tonics  from  time  to  time.  The  salt  I  pre- 
fer and  have  used  for  forty  and  more 
years,  is  the  acetate  of  potassium,  in  doses 
of  from  fifteen  to  thirty  grains,  generally 
combined  with  nux  vomica  and  fluid  ex- 
tract of  rumex  root,  given  three  times 
daily,  half  an  hour  before  meals,  well 
diluted.  Fluid  extract  of  cascara  is  com- 
monly added,  in  doses  sufficient  to  secure 
full  and  free  daily  action  of  the  bowels. 
Iron  and  phosphatic  preparations  are  also 
called  for  in  most  cases,  even  over  long 
periods,  and  very  many  other  remedies 
may  be  needed  from  time  to  time  to  ren- 
der the  metabolism  correct. 

Morphia  is  very  commonly  given  to  can- 
cer patients,  even  soon  after  they  have 
begun  to  experience  pain,  but  this  is  very 
undesirable,  as  it  interferes  seriously  with 
the  action  of  the  internal  organs,  and  les- 
sens  the   chance   of   recovery.    In   many 


244  MEDICAL  ASPECTS  OF  CANCER 

cases  I  have  found  relief  from  aspirin, 
given  even  every  two  hours.  This  not 
only  diminishes  the  neuritic  symptoms,  but 
even  helps  in  the  treatment  by  rectifying 
the  rheumatic  element,  which  is  often  a 
feature  in  cancer.  In  looking  over  my 
histories  of  cases  it  is  interesting  to  note 
that  practically  no  morphine  has  been 
taken  by  them,  even  in  cases  of  recurrence 
after  operations  and  those  that  have  ended 
fatally.  When  under  full  and  proper  treat- 
ment, as  outlined,  there  seems  to  be  rela- 
tively little  pain  at  any  time. 

I  will  not  burden  you  with  statistics 
showing  the  advantages  of  the  medical 
treatment  of  cancer,  as  already  outlined, 
nor  with  histories  of  cases.  Suffice  it  to 
say,  that  in  my  long  experience  there  is 
absolutely  no  comparison  between  the  re- 
sults thus  obtained  and  those  claimed  by 
surgeons.  In  dozens  of  patients  I  have 
seen  breast  tumors  which  had  been  di- 
agnosed as  cancer,  often  by  several  com- 
petent surgeons,  in  whom  the  tumor  has 


MEDICAL  TREATMENT        245 

entirely  disappeared  and  remained  ab- 
sent, when  the  patient  had  been  faithful 
to  treatment  long  enough.  Some  of  these 
cases,  which  I  have  reported,  date  back 
thirty  years  and  more,  for  some  of  whom 
operations  had  been  arranged  for  by  sur- 
geons, and  a  number  of  them  I  have 
watched  for  10  to  16  years  and  they 
have  remained  entirely  well.  I  have  re- 
ported two  cases  of  uterine  cancer,  who 
had  been  refused  operation  by  several 
surgeons,  and  had  been  proven  micro- 
scopically to  be  very  malignant,  who  have 
been  perfectly  well  over  two  years,  as  tes- 
tified to  by  the  examination  of  others.  A 
case  of  cancer  of  the  bladder,  treated  also 
by  fulguration,  has  remained  well  over 
two  years,  and  one  of  the  prostate  im- 
proved marvellously,  but  was  lost  sight  of. 
In  two  cases  of  cancer  of  the  stomach,  so 
diagnosed  by  others,  the  trouble  seems 
to  have  disappeared. 

It  has  been  difficult  in  a  single  address 
to  present  satisfactorily  so  great  and  im- 


246  MEDICAL  ASPECTS  OF  CANCER 

portant  a  subject  as  the  medical  treatment 
of  cancer.  But  I  trust  that  enough  has 
been  said  to  impress  you  with  the  fact 
that  the  disease  has  medical  relations 
which  offer  more  hope  than  the  knife, 
especially  if  the  case  is  taken  strongly 
in  hand  from  the  beginning  and  the  treat- 
ment continued  faithfully  and  long  enough. 
Already  the  subject  has  attracted  atten- 
tion everywhere,  and  during  the  past  year 
there  has  been  a  singular  dearth  of  sur- 
gical writings  on  cancer  in  the  journals, 
and  an  increasing  number  of  articles 
along  the  lines  here  considered.  The  good 
results  are  perhaps  shown  slightly  in  the 
Mortality  Eecords  of  cancer  by  the  New 
York  City  Board  of  Health,  for  the  first 
six  months  of  this  year.  During  this  pe- 
riod the  deaths  from  malignant  disease 
were  2480  against  2488,  or  eight  deaths 
less  from  cancer  than  during  the  same 
period  last  year,  whereas  those  of  last 
year  were  127  more  than  in  the  first  half 
of  the  preceding  year,  1916.    This  in  spite 


MEDICAL  TEEATMENT        247 

of  an  increased  population  and  an  in- 
crease in  the  total  number  of  deaths, 
amounting  to  423,  in  the  first  half  of  this 
year,  over  the  first  six  months  of  1917. 


CHAPTER  XII 

PRECANCEROUS    CONDITIONS 

Heretofore  the  study  of  **  precancerous 
conditions''  has  been  confined  ahnost  exclu- 
sively to  microscopical  investigations,  and 
the  clinical  observation  of  the  occasional 
degeneration  of  certain  originally  innocent 
lesions  into  those  of  malignant  character. 
The  result  of  this  has  been  that  cancer 
has  been  looked  upon  as  a  wholly  local 
affair,  idiopathic,  so  to  speak,  with  little 
or  no  regard  to  the  causes  which  lead  up 
to  the  transformation  of  previously  nor- 
mal tissue  cells  into  those  of  disease,  that 
is,  to  the  basic  cause  of  cancer. 

The  search  has  been  persistently  made 
for  some  extraneous  cause,  such  as  para- 
sitism, but  in  vain.  When  the  theory  of 
*^ embryonic  rests"  was  evolved  this  was 
eagerly  seized  on  as  a  basis  for  cancer 
248 


PRECANCEROUS  CONDITIONS  249 

genesis ;  but  soon  all  recognized  that  these 
alone  conld  not  answer  the  problem,  as 
they  existed  in  numbers  in  every  one,  and 
there  must  be  some  exciting  cause  which 
induces  them  to  take  on  and  keep  such 
rampant  action  as  belongs  to  cancer.  Lo- 
cal injury  or  irritation  was  then  cited  as 
a  cause,  but  it  was  soon  realized  that  this 
could  not  account  for  the  persistent  ma- 
lignant action  in  the  deranged  cells,  for 
other  injuries  in  cancer  patients  healed 
kindly.  And  so  one  theory  has  followed 
another  in  a  bewildering  manner,  and  still 
cancer  goes  on,  with  a  death-rate  increas- 
ing over  twenty-five  per  cent,  since  1900, 
as  shown  by  the  United  States  mortality 
tables,  fully  90  per  cent,  of  those  once 
affected  dying  of  the  disease. 

And  yet  all  along  the  last  hundred  years 
some  of  those  who  had  most  knowledge 
of  and  experience  with  cancer,  have,  from 
time  to  time,  acknowledged  the  futility  of 
surgical  operations  to  control  the  disease, 
and  have  insisted  that  there  was  some  con- 


250  MEDICAL  ASPECTS  OF  CANCER 

stitutional  state  which  was  the  real  "pre- 
cancerous condition."  John  Abernethy, 
in  1816,  wrote:  "There  can  be  no  sub- 
ject which  I  think  more  likely  to  interest 
the  mind  of  the  surgeon  than  that  of  an 
endeavor  to  amend  and  alter  the  state 
of  a  cancerous  constitution.  The  best 
timed  and  best  conducted  operation  brings 
with  it  nothing  but  disgrace  if  the  dis- 
eased propensities  of  the  constitution  are 
active  and  powerful.  It  is  after  an  oper- 
ation that,  in  my  opinion,  we  are  most 
particularly  incited  to  regulate  the  con- 
stitution, lest  the  disease  should  be  re- 
vived or  renewed  by  its  disturbance.'' 

Many  will,  of  course,  say  that  this  was 
written  long  before  the  days  of  modem 
surgery,  and  before  experience  and  path- 
ology had  demonstrated  the  necessity  of 
very  complete  excision  of  neighboring  tis- 
sues, and  before  the  modern  crusade  for 
very  early  operation  and  the  removal  of 
"precancerous  lesions.''  But  the  answer 
to  this  is  that  with  all  the  intelligent  and 


PEECANCEROUS  CONDITIONS  251 

magnificent  efforts  of  modern  surgery,  the 
mortality  from  this  dread  disease,  as  al- 
ready mentioned,  is  steadily  rising  year  by 
year,  even  up  to  the  present  date.  If,  more- 
over, the  views  to  be  presented  regard- 
ing the  real  nature  of  cancer,  and  of  ' '  pre- 
cancerous conditions''  be  correct,  there 
is  no  likelihood  that  the  present  cry  for 
the  instant  removal  of  everything  suspect- 
ed to  be  cancerous,  or  precancerous,  will 
greatly  stay  this  persistent  increase  in  the 
death  rate  of  cancer.  For,  leaving  the  ba- 
sic cause  of  the  malady  unchecked,  new 
foci  of  disease  will  arise  in  the  same  man- 
ner as  did  the  original  product  of  the 
wrong  blood  condition,  which  was  excised. 
The  limits  of  a  brief  paper  prevent  the 
quoting  of  a  very  large  amount  of  cor- 
roborative opinion  of  eminent  surgeons, 
writing  on  cancer,  which  has  been  pre- 
sented elsewhere,  but  brief  reference  must 
be  made  to  the  views  of  one  whom  all  re- 
spect, and  whose  knowledge  of  and  experi- 
ence with  cancer  none  can  question. 


252  MEDICAL  ASPECTS  OF  CANCER 

Dr.  Wm.  J.  Mayo,  in  his  recent  address 
as  President  of  the  American  Surgical 
Association  on  ^^The  Prophylaxis  of  Can- 
cer/'* spoke  repeatedly,  in  no  uncertain 
manner,  in  regard  to  the  probability  of 
there  being  some  constitutional  condition 
back  of  the  local  lesion  commonly  recog- 
nized as  such.  And  yet  I  fear  that  his 
clear  words  alone  will  make  little  impres- 
sion upon  the  majority  of  readers,  who  are 
so  obsessed  with  the  idea  of  the  local  na- 
ture of  cancer,  and  so  possessed  by  the 
present  craze  for  surgery.  Quite  as  lit- 
tle impression  would  probably  be  made  by 
the  remarks  of  Dr.  John  B.  Murphy,  of 
Chicago,  in  his  presidential  address  before 
the  American  Association  of  Clinical  Sur- 
gery. He  said  that  if  he  were  to  go  back 
twenty-five  years  and  begin  again  he 
would  certainly  take  up  medical  work 
rather  than  surgical,  for  surgery  had 
about  reached  its  limits,  whereas  the  pos- 
sibilities of  scientific  medicine  were  bound- 


*  Mayo  (Annals  of  Surgery,  June,  1914,  page  805). 


PEECANCEROUS  CONDITIONS  253 

less.  He  repeatedly  in  Ms  clinics  has  ex- 
pressed himself  most  pessimistically  in  re- 
gard to  the  ultimate  results  of  the  surgi- 
cal treatment  of  carcinoma,  especially  in 
those  patients  who  are  fat,  and  with  lax 
tissue,  that  is,  exhibiting  evidences  of  im- 
perfect metabolism. 

The  medical  profession  and  the  laity 
have  become  so  infatuated  with  the  value 
of  laboratory  and  research  investigations 
that  clinical  medicine  has  been  put  too 
much  in  the  background,  and  is  often  dis- 
credited, unless  supported  by  the  micro- 
scope or  test-tube.  This  is  especially  true 
in  regard  to  cancer.  For  while  surgeons 
make  the  diagnosis  and  operate  largely  on 
clinical  grounds,  they  are  very  loath  to 
acknowledge  the  correctness  of  the  diagno- 
sis when  cancer  has  disappeared  and  re- 
mained absent  for  years  under  dietetic  and 
medical  treatment,  even  though  the  diag- 
nosis had  previously  been  made  carefully 
by  several  physicians  and  surgeons ;  for  it 


254  MEDICAL  ASPECTS  OF  CANCER 

is,  of  course,  manifestly  improper  to  make 
a  biopsy  in  these  cases. 

What  is  the  reason  for  this  reluctance? 
It  is  because  the  disease  has  too  often 
been  considered  incurable,  except  by  sur- 
gical measures,  and  yet  with  these  alone 
it  makes  a  steady  increase  in  morbidity 
and  mortality  which  is  truly  alarming.  Is 
it  not  time  for  the  medical  profession  to 
recognize  that  just  as  tuberculosis  mor- 
tality has  been  reduced  over  25  per  cent, 
since  1900,  by  proper  feeding,  living,  and 
medication,  so  cancer  can  be  checked  in 
its  25  per  cent,  rise  of  mortality,  in  the 
same  period,  by  measures  of  like  charac- 
ter? 

It  is  quite  impossible  in  the  limits  of 
this  paper  to  present  in  any  full  manner 
the  grounds  for  the  rational  belief  in  a 
constitutional  nature  and  origin  of  cancer, 
which  have  been  collected  in  the  works 
already  referred  to,  but  a  brief  mention 
may  be  made  of  the  same.  Unfortunately 
for  the  belief  of  some,  laboratory  and  re- 


PRECANCEROUS  CONDITIONS  255 

search  work  have  not  yet  been  directed 
much  to  the  metabolic  errors  leading  up 
to  cancer,  but  the  relatively  few  studies 
which  have  been  made  have  confirmed  in 
a  singular  manner  the  results  of  clinical 
observation  and  statistical  investigation. 
From  what  can  be  learned,  some  of  the 
la"boratories  are  now  taking  up  the  subject, 
and  there  is  hope  that  with  their  help 
newer  and  sounder  ideas  in  regard  to  can- 
cer will  prevail. 

As  an  indication  of  the  faulty  metabol- 
ism of  cancer  patients  it  is  to  be  noted 
that  the  urine,  under  careful  volumetric 
analysis,  is  rarely  if  ever  that  of  health; 
this  does  not  refer  to  the  presence  of 
albumen  or  sugar,  but  to  the  relative  pro- 
portion of  the  many  other  ingredients 
which  compose  that  excretion,  which  can 
be  only  lightly  touched  upon.  Many  writ- 
ers have  reported  great  errors  in  the  ni- 
trogen partition,  and  Eeid,  from  the  Can- 
cer Research  Laboratory  of  Manchester, 
England,  states  that  he  has  found  an  in- 


256  MEDICAL  ASPECTS  OF  CANCER 

crease  of  amino-acid  nitrogen  in  practi- 
cally every  case  of  cancer  he  had  exam- 
ined. This  faulty  nitrogenous  metabolism 
I  have  constantly  found  not  only  in  well- 
developed  cases,  but  also  in  very  early 
cases  of  breast  tumors  which  had  been 
diagnosed  as  cancer,  and  also  in  cases 
where  the  cancerous  breast  had  been  re- 
moved. Blumenthal  also  states  that  oxy- 
proteic  acids  are  increased  even  in  very 
early  cancer,  and  independently  of  the  size 
of  the  tumor  and  degree  of  cachexia. 

The  total  output  of  urinary  solids  is 
found  to  be  greatly  deficient  both  in  pa- 
tients with  the  very  early  beginning  of  the 
disease  and  during  its  entire  course,  un- 
less influenced  otherwise  by  medical  care. 
This  I  have  found  to  be  so  universally 
true  in  dozens  of  cancer  cases,  that  I  have 
come  to  look  upon  it  as  a  feature  of  the 
greatest  importance  in  connection  with  the 
disease.  In  a  very  large  number  of  cases 
I  have  had  the  total  urine  saved  and  re- 
corded daily,  over  long  periods,  and  sam- 


PEECANCEEOUS  CONDITIONS  257 

pies  thoroughly  analyzed  every  week,  or 
oftener,  and  the  findings  have  been  to 
me  the  surest  indications  for  treatment; 
I  refer  to  the  total  quantity,  the  estima- 
tion of  solids,  the  volumetric  acidity,  the 
urea,  chlorides,  phosphates,  sulphates,  and 
indican.  While  we  have  not  yet  arrived 
at  a  point,  and  probably  never  will,  where 
any  specific  changes  in  the  urine  can  be 
regarded  of  great  importance  in  the  diag- 
nosis or  prognosis  of  cancer,  long  obser- 
vation has  convinced  me  that  a  very  care- 
ful volumetric  study  of  this  excretion  will 
demonstrate  errors  of  metabolism  in  the 
system  whose  long  existence  forms  one  of 
the  *^ precancerous  conditions." 

Homely  as  may  seem  the  observation,  I 
want  to  call  attention  to  imperfect  intes- 
tinal action  as  one  of  the  causes  and  in- 
dications of  a  **  precancerous  condition '* 
in  the  blood  which  is  of  importance.  Sel- 
dom do  I  find  a  cancer  patient,  either  with 
very  early  or  late  lesion,  who  has  habit- 
ually  a  normal  excretory   action   of  the 


258  MEDICAL  ASPECTS  OF  CANCER 

bowels.  In  most  instances  there  is  habit- 
ual constipation  with  an  irregular  de- 
pendence on  laxatives,  or  there  is  a  his- 
tory of  neglect  with  alternate  obstipation 
with  occasional  natural  relief,  often  by- 
diarrhea.  Long  retention  of  feces  in  the 
large  intestine  tends  to  fermentation  with 
enormous  micrococcic  development,  whose 
resulting  toxins  are  absorbed  and  are  an 
essential  element  in  the  perverted  nutri- 
tion of  cancer,  a  *' precancerous  condi- 
tion.'^ 

I  have  been  largely  quoted  as  maintain- 
ing that  meat  is  the  cause  of  cancer,  but 
that  is  but  a  partial  and  a  false  concep- 
tion. Experience  and  the  study  and  an- 
alysis of  laboratory  work  have  fully  satis- 
fied me  that  cancer  is  one  of  the  end- 
products  of  faulty  metabolism,  and  this 
disordered  and  imperfect  metabolism,  re- 
sulting in  some  chemico-physiological  de- 
rangement of  the  blood-stream,  may  be 
produced  in  many  ways.  Statistics  show 
clearly  that  as  the  consumption  of  meat 


PEECANCEROUS  CONDITIO:NrS  259 

has  increased  in  various  countries,  the 
mortality  from  cancer  has  steadily  risen; 
thus,  in  England  the  yearly  consumption 
of  meat  has  doubled  during  the  past  fifty 
years,  and  the  mortality  from  cancer  has 
increased  four  fold.  But  it  has  also  been 
shown  that  cancer  has  increased  with  the 
consumption  of  coffee,  and  also  in  those 
who  indulge  habitually  in  alcoholic  bev- 
erages. 

These  errors  in  diet,  however,  are  only 
some  of  the  elements  belonging  to  modem 
civilization  which  have  contributed  to  the 
steady  increase  in  the  mortality  of  a  num- 
ber of  chronic  ailments  whose  death-rate 
is  also  increasing  at  an  alarming  rate. 
Thus,  according  to  the  United  States  Mor- 
tality Statistics,  the  deaths  from  apoplexy 
and  Bright 's  disease  have  each  increased 
over  15  per  cent,  from  1900  to  1913,  those 
from  organic  heart  diseases  almost  20  per 
cent.,  and  from  cancer  over  25  per  cent, 
during  the  same  period.  All  tiie  first 
three  are  recognized  to  be  largely  due  to 


260  MEDICAL  ASPECTS  OF  CANCER 

the  incidents  of  modem  civilization,  main- 
ly in  the  line  of  erroneous  eating  and 
drinking,  and  the  conclusion  seems  almost 
irresistible  that  the  coincident  rise  in  the 
cancer  death-rate  is  due  to  the  same 
cause. 

The  limits  of  this  paper  forbid  fuller 
development  of  the  subject,  but  the  fur- 
ther contributory  causes  to  the  poisoned 
blood  stream  which  produces  and  nour- 
ishes the  rampant  cells  of  carcinoma  in 
their  destructive  course,  with  all  the  po- 
tentialities of  the  disease,  must  be  ap- 
parent to  all.  Such  are  the  nervous  strain 
and  stress  of  modem  life,  often  with  its 
hurried  eating  and  imperfect  mastication 
and  insalivation,  the  over-indulgence  in 
wrongly  selected,  prepared,  and  combined 
food  and  drink,  luxurious  and  indolent 
habits  in  many,  etc.,  etc. 

The  subject  is  a  great  one,  worthy  of 
profound  study,  and  the  only  wonder  is 
that  there  has  been  such  a  myopic  tend- 
ency in  scientists  and  surgeons,  who  have 


PEECANCEROUS  CONDITIONS  261 

overlooked  the  broad  medical  principles 
which  underlie  all  nutrition,  both  benign 
and  malignant,  and  have  spent  so  much 
time,  money,  and  energy  in  searching  for 
some  specific  cause  of  cancer,  and  in  the 
surgical  removal  of  the  accessible  prod- 
iccts  of  the  disease,  while  leaving  its 
main  and  fundamental  causes  uncared  for. 


CHAPTER  Xni 

CANCER    IN    RELATION    TO    BODY    ELIMINATION 

With  the  large  number  of  laboratory 
studies  which  have  been  reported  concern- 
ing blood  and  urinary  changes  in  cancer, 
it  is  surprising  that  so  little  attention  has 
been  paid  to  the  clinical  importance  of 
these  findings,  and  to  the  relation  which 
body  elimination  bears  to  the  production 
and  continuance  of  the  disease.  The  laity 
as  well  as  the  profession  have,  of  late 
years,  become  so  obsessed  with  the  idea 
of  its  purely  local  character,  and  so  car- 
ried away  with  the  craze  for  surgery,  that 
practically  every  one  thinks  only  of  local 
operative  treatment,  by  the  knife,  ic-ray, 
radium,  etc.  And  thus  it  happens  that 
when  cancer  is  suspected  or  diagnosed, 
the  physician  feels  helpless  and  the  pa- 
tient only  waits  for  an  operation  or  death, 
262 


BODY  ELIMINATION  263 

which  latter  is  now  acknowledged  to  fol- 
low from  the  disease  in  about  ninety  per 
cent,  of  those  once  affected. 

And  yet  for  many  years  eminent  sur- 
geons have  time  and  again  acknowledged 
their  inability  to  cope  with  cancer,  as  such, 
and  have  contented  themselves  with  at- 
tempting to  remove  the  product  of  the  dis- 
ease, namely,  the  malignant  new  growth, 
glands,  etc.  But  little  regard  has  been 
given  thus  far  to  the  real  cause  of  this 
new  growth,  although  infinite  labor  has 
been  expended  in  the  laboratory  to  dis- 
cover its  histological  characters,  mode  of 
development,  etc.  And  all  this  in  spite  of 
the  fact  which  every  one  must  recognize 
that  all  growth,  whether  normal,  abnor- 
mal, or  malignant,  depends  upon  the  char- 
acter of  the  blood  supply,  which  again 
derives  its  quality  from  the  food  and 
drink  taken,  and  the  manner  in  which  the 
metabolism  of  the  system  is  carried  out. 

Cancer  has  too  long  been  regarded  as  a 
purely  surgical  affection,  and  the  surgeon 


264  MEDICAL  ASPECTS  OF  CANCER 

as  the  sole  arbiter  of  the  fate  of  those 
suffering  from  this  most  fatal  disease. 
With  the  steady  rise  in  its  mortality,  of 
over  twenty-five  per  cent,  since  1900,  as 
shown  by  the  United  States  mortality  ta- 
bles, under  this  line  of  action,  it  would 
seem  well  for  the  medical  men  to  take  up 
the  study  and  to  endeavor  to  learn  if 
there  is  not  some  basic  cause,  thus  far 
overlooked,  which  may  be  found  in  the 
metabolic  action  of  the  system,  as  influ- 
enced in  many  ways,  such  as  by  the  diet, 
mode  of  life,  etc.  Should  we  not  try  to 
discover  why  cancer  is  increasing  so  great- 
ly with  civilized  life,  while  it  is  rare  in 
some  animals  and  seldom  if  ever  seen  in 
certain  aborigines?  Literature  is  full  of 
isolated  facts  tending  to  show  conclusively 
that  the  disease  is  but  an  aberrant  action 
of  originally  normal  tissue  cells,  resulting 
from  a  vitiated  blood  stream. 

Space  does  not  permit  the  full  presenta- 
tion of  facts  which  have  been  collated  else- 
where, nor  to  do  more  than  mention  the 


BODY  ELIMINATION  265 

names  of  some  of  the  eminent  surgeons, 
there  quoted,  who  have  expressed  strongly 
their  belief  in  the  constitutional  nature  of 
cancer,  from  erroneous  living.  Among 
these  are  Lambe,  Abernethy,  Willard 
Parker,  Sir  Astley  Cooper,  Sir  James 
Paget,  Esmarck,  and  Sir  Arbuthnot  Lane, 
as  also  Walshe,  in  his  classical  study  of 
cancer.  Finally,  Dr.  William  J.  Mayo,  in 
his  recent  president's  address  before  the 
American  Surgical  Association,  has  ex- 
pressed himself  in  no  uncertain  way  in 
regard  to  there  being  some  constitutional 
cause  leading  up  to  the  aberrant  action  of 
cells  in  cancer. 

While  the  exact  condition  of  the  blood 
which  excites  normal  cells  to  become  can- 
crogenetic  and  then  feeds  them  in  their 
luxuriant  growth,  is  not  capable  of  demon- 
stration yet,  and  perhaps  never  will  be, 
clinical  study  reveals  certain  conditions  of 
the  system  so  constantly  observed  in  pa- 
tients with  this  disease  that  there  can  be 
little  if  any  doubt  that  they  are  contribu- 


266  MEDICAL  ASPECTS  OF  CANCER 

tory  elements,  at  least,  to  the  production 
of  malignant  disease;  these  relate  to  the 
conditions  of  faulty  metabolism  and  faulty 
imperfect  body  elimination.  These  errors 
may  be  observed,  not  only  in  advanced 
and  recurrent  cases  of  cancer,  but  also  in 
those  which  are  in  very  early  stages;  in- 
deed their  occurrence  in  recently  forming 
cancer,  and  in  patients  soon  after  opera- 
tion forms  a  strong  argument  for  their 
causative  relation  to  the  disease. 

The  evidences  of  imperfect  metabolism 
and  faulty  body  elimination  in  cancer  are 
found  in  the  condition  of  the  blood,  and  in 
excretions  from  the  kidneys,  bowels,  and 
skin,  and  minute  and  careful  study  will 
seldom  fail  to  detect  these  departures 
from  normal  in  patients  with  this  disease. 
It  is  impossible  in  this  brief  article  to  pre- 
sent any  full  account  of  these  errors  which 
have  been  elaborated  in  the  references  al- 
ready given,  but  a  brief  mention  may  be 
made  of  some  of  the  most  important 
items. 


BODY  ELIMINATION  267 

The  blood  is  known  to  present  great  de- 
generative changes  in  cancer,  which  in- 
crease as  the  disease  advances;  the  hemo- 
globin content  tends  constantly  to  fall 
and  the  red  cells  to  exhibit  various  phases 
of  degeneration.  The  white  cells  increase 
and  the  proportion  of  their  varieties 
changes  greatly.  Unfortunately  few  if  any 
studies  have  been  made  in  precancerous 
conditions  of  relative  health,  but  it  has 
been  recorded  that  after  the  surgical  re- 
moval of  a  cancerous  mass  there  has  been 
a  decided  increase  of  hemoglobin,  as  I 
have  witnessed,  and  a  high  leucocytosis 
has  disappeared,  only  to  return  again 
with  the  recurrence  of  the  tumor.  It  is 
recognized  that  the  cancerous  cells  them- 
selves secrete  a  malignant  hormone,  which 
aids  in  increasing  the  depraved  condition 
of  the  blood  as  the  cancer  advances;  for 
just  as  the  particular  and  peculiar  cells 
of  the  various  secretory  and  excretory  or- 
gans produce  a  hormone  which  probably 
influences  other  secretions,  so  all  the  cells 


268  MEDICAL  ASPECTS  OF  CANCER 

of  the  body,  healthy  and  diseased,  produce 
Bomething  of  a  secretion  which  has  some 
influence  on  the  economy. 

When  cancer  juice  is  injected  intrav- 
enously a  marked  lymphocytosis  arises, 
which  is  followed  by  the  appearance  of 
large  mast  cell  myelocytes  in  the  blood. 
This  cancer  juice  is  supposed  to  autotoxie 
in  cancer  patients,  and  to  comprise  al- 
buminoids, which  being  in  quantities  too 
great  to  be  quickly  neutralized,  poison  the 
system,  especially  the  blood  and  the  hema- 
topoietic organs.  In  cancerous  cachexia  a 
diminution  of  carbonic  acid,  a  constantly 
diminishing  alkalinity,  and  an  increase  of 
acid  principles  in  the  blood  have  been 
definitely  demonstrated,  pointing,  in  all 
probability,  to  the  existence  of  an  acid  in- 
toxication. 

The  urine  in  cancer  has  been  investi- 
gated by  very  many  observers,  and  al- 
though no  definite  and  specific  changes 
have  been  as  yet  found  which  are  surely 
indicative  of  the  disease,  very  many  de- 


BODY  ELIMINATION  269 

partures  from  the  normal  have  been  re- 
ported which  are  of  significance,  and  un- 
der complete  volumetric  analysis  the  urine 
of  a  subject  of  cancer  is  rarely  if  ever 
that  of  health.  Many  observers  agree  that 
there  is  a  disturbance  of  protein  metab- 
olism manifested  in  the  urine,  and  an  in- 
crease in  colloid  nitrogen  to  more  than 
double  the  normal  amount:  there  has  also 
been  reported  an  increased  elimination  of 
xanthin,  oxyproteic  acid,  and  urinary  am- 
monia. 

The  urea  in  the  urine  is  almost  invari- 
ably diminished,  often  very  greatly,  as  I 
have  verified  time  and  again  in  many 
cases.  There  is  also  an  increase  of  amino- 
acid  nitrogen,  showing  that  the  liver,  even 
when  not  involved  in  the  disease,  is  still 
unable  to  perform  its  functions  in  syn- 
thetizing  urea. 

The  urinary  secretion  will  constantly  be 
found  to  be  extremely  deficient,  both  as  to 
the  actual  quantity  passed  in  twenty-four 
hours,  and  in  its  total  solid  elimination, 


270  MEDICAL  ASPECTS  OF  CANCER 

which,  of  course,  is  the  true  indication  as 
to  the  efficiency  of  this  excretion.  In  many 
cases,  even  of  very  early  cancer,  in  which 
the  urinary  secretion  has  been  measured 
and  recorded  every  day  for  weeks,  I  have 
found  the  elimination  of  solids  often  less 
than  one  half  of  the  amount  called  for  by 
the  body  weight  of  the  patient.  As  the 
tumor  has  melted  away  under  proper  diet- 
ary and  other  general  treatment,  the  kid- 
neys have  often  brought  up  the  removal 
of  waste  material  to  a  normal  standard. 
So  constantly  have  I  observed  this  faulty 
urinary  elimination  early  and  late  in  these 
subjects,  that  I  cannot  but  believe  that  it 
indicates  some  defect  in  metabolism  which 
has  a  bearing  upon  the  genesis  and  rebel- 
liousness of  cancer. 

The  action  of  the  bowels,  in  regard  to 
their  true  eliminative  function,  is  a  more 
difficult  problem  to  study,  and  yet  from 
long  observation  I  am  convinced  that  it 
plays  a  most  important  part  in  connection 
with  cancer.    I  am  not  aware  of  any  lab- 


BODY  ELIMINATION  271 

oratory  studies  which  have  been  made 
concerning  the  intestinal  discharge  in  this 
disease,  and  my  deductions  are  entirely 
clinical.  Sir  Arbuthnot  Lane,  in  one  of 
his  lectures  on  intestinal  stasis,  has  re- 
cently emphasized  the  fact  that  one  of  the 
terminal  results  of  this  may  be  cancer, 
and  the  more  I  have  considered  the  sub- 
ject, in  connection  with  very  many  pa- 
tients, the  more  the  truth  of  this  state- 
ment is  impressed  upon  me.  It  will  sur- 
prise many  to  learn  how  very  commonly 
there  is  imperfect  intestinal  elimination  in 
the  subjects  of  cancer,  both  in  the  very 
early,  formative  stages  and  throughout  the 
whole  course  of  the  disease,  which  is  fur- 
ther accentuated  when  the  time  comes  for 
them  to  take  morphine.  So  commonly  have 
I  recorded  this,  especially  in  private  pa- 
tients, that  I  might  almost  say  that  is  the 
rule,  and  time  and  again  I  have  noticed 
that  if  real  constipation  occurs  there  is  an 
increase  of  pain  in  a  cancerous  lesion, 
with  more  or  less  of  relief  from  active 


272  MEDICAL  ASPECTS  OP  CANCER 

purgation.  The  constant  occurrence  of 
this  imperfect  intestinal  elimination  points 
strongly  to  the  possibility  that  the  toxins 
produced  by  the  millions  of  micro-organ- 
isms generated  through  intestinal  sta- 
sis and  fecal  putrefaction  are  the  real,  in- 
cidental cause  of  cancer.  While  this  is 
only  a  clinical  conclusion,  it  is  hoped  that 
laboratory  research  turned  in  this  direc- 
tion will  confirm  the  finding. 

The  liver  has  been  shown  by  many  re- 
searches to  exhibit  many  departures  from 
normal  action  in  connection  with  cancer. 
Reid,  from  the  Cancer  Research  Labora- 
tory, in  Manchester,  England,  reports  that 
**in  cancer  the  liver,  while  not  involved 
in  the  disease,  is  still  unable,  for  some 
reason,  to  perform  its  functions  in  syn- 
thetizing  urea.  The  organ  is  functionally 
injured,  no  lesions  having  been  found  to 
explain  its  insufficiency  .  .  .  cancerous 
subjects  form  proteids  which  the  liver  is 
unable  to  deal  with,  so  that  they  are  ex- 
creted unchanged,  or  nearly  so.'*     Blum- 


BODY  ELIMINATION  273 

enthal  states  that  urobilin  is  increased  in  a 
large  proportion  of  cases  of  cancer,  and 
others  have  confirmed  hepatic  functional 
disorders  in  connection  with  the  disease. 

The  relation  of  the  elimination  from  the 
skin  to  cancer  has,  of  course,  never  been 
studied,  and  perhaps  never  will  be.  But 
there  are  certain  considerations  which  may 
be  of  importance  in  connection  with  the 
general  disturbance  or  failure  of  elimina- 
tion in  this  disease.  We  know  that  the 
skin  performs  most  important  functions  in 
connection  with  regulating  the  heat  of  the 
body.  While  the  relative  amount  of  solids  in 
the  sweat  is  small,  the  daily  total  given  off 
by  the  sudoriferous  and  sebaceous  glands 
is  not  inconsiderable,  and  its  character  is 
known  to  vary  considerably  under  cer- 
tain conditions,  urea  and  uric  acid  occur- 
ring at  times,  while  cholesterin,  an  element 
of  importance  in  cancer,  appears  in  the  se- 
baceous secretion,  etc.  In  cancer  the  skin  is 
apt  to  be  dry  and  inactive,  and  possibly 
later   researches   may  show   that  it   also 


274  MEDICAL  ASPECTS  OF  CANCER 

shares  in  the  deranged  metabolic  condi- 
tion connected  therewith. 

It  is  realized  that  the  study  of  cancer 
along  the  lines  here  indicated  is  yet  in  its 
infancy,  as  it  has  heretofore  been  regard- 
ed almost  wholly  from  its  histological  and 
surgical  aspects.  The  microscope  and  ex- 
perimental work  on  animals  have  seemed 
to  engross  most  of  the  attention,  to  the 
relative  exclusion  of  careful  clinical  ob- 
servations of  the  real  ''precancerous"  con- 
ditions occurring  in  the  system,  which 
lead  up  to  the  disease. 

Endocarditis,  nephritis,  and  apoplexy 
are  shown,  by  the  United  States  mortality 
tables,  to  have  had  a  continuous  and  great 
rise  in  their  death  rate,  per  100,000,  of 
late  years,  and,  as  already  mentioned,  can- 
cer has  had  also  a  coincident  rise  in  mor- 
tality of  over  twenty-five  per  cent,  since 
1900.  As  the  three  former  diseases  are 
recognized  to  be  largely  due  to  the  inci- 
dents of  modem  civilization,  mainly  in 
the  line  of  erroneous  eating  and  drinking, 


BODY  ELIMINATION  275 

it  would  seem  reasonable  to  ascribe  can- 
cer to  the  same  cause.  Faulty  metabolism 
and  imperfect  elimination  are  characteris- 
tics of  endocarditis,  nephritis,  and  apo- 
plexy, and  close  and  continued  observation 
will  show  them  to  be  integral  features  of 
the  bodily  condition  leading  up  to  and  as- 
sociated with  cancer. 


CHAPTER  XIV 

CANCER  AND   CIVILIZATIOIT/ 

Civilization  has  its  advantages  and  also 
its  disadvantages.  All  recognize  that  the 
mortality  from  tuberculosis  had  steadily 
been  increasing  under  the  evil  effects  of 
overcrowding  and  bad  sanitation,  incident 
to  advancing  civilization,  until  wiser 
methods  have  succeeded  more  recently  in 
arresting  its  rising  progress,  and  greater 
care  has  lessened  its  death  rate  immensely, 
almost  30  per  cent.,  from  1900  to  1916. 

Cancer  deaths  have  also  long  been  stead- 
ily increasing  all  over  the  world,  under 
advancing  civilization,  as  has  been  often 
shown.  But  instead  of  diminishing,  as  in 
the  case  of  tuberculosis,  they  have  in- 
creased   so    surely    and    steadily    of    late 


*Read  at  the  Forty-second  Annual  Meeting  of  the 
American  Academy  of  Medicine,  New  York  City,  June 
4.  1917. 

276 


CANCER  AND  CIVILIZATION  277 

that  unless  something  is  done  to  arrest 
its  continued  progress,  cancer  will  soon 
rival  the  latter  disease  in  its  morbidity 
and  mortality. 

According  to  the  mortality  statistics  of 
the  United  States,  the  death  rate  from 
tuberculosis  in  1910  was  201.9  per  100,000 
population,  which  under  most  careful  med- 
cal  supervision  has  steadily  dropped,  until 
in  1916  there  were  only  141.6  deaths  per 
100,000  population,  or  a  diminution  of 
over  29.8  per  cent. 

During  the  same  period  the  deaths  from 
cancer  under  solely  surgical  management 
have  risen  from  63  in  1900  to  81.8  in 
100,000  living  in  1916,  or  over  28.84  per 
cent. ;  that  is,  almost  equal  the  rate  tuber- 
culosis has  fallen.  Thus  the  mortality  of 
the  two  have  approached  each  other  in 
these  15  years  by  over  58.64  per  cent. ;  and 
if  the  same  progress  in  each  direction 
should  continue,  the  death  rate  from  can- 
cer will  far  outstrip  that  of  tuberculosis 
in  16  years  more. 


278  MEDICAL  ASPECTS  OF  CANCEB 

The  rational  deduction  of  this  would 
seem  to  be  that  we  should  inquire  as  to 
whether  there  is  not  something  wrong  in 
our  present  conception  of  cancer  and  its 
treatment.  This  is  not  the  time  nor  place 
to  discuss  this  real  cancer  problem,  which 
has  been  fully  met  elsewhere,  as  our  in- 
terest is  as  to  how  far  and  in  what  man- 
ner modern  civilization  is  responsible  for 
the  increase  of  cancer  morbidity  and  mor- 
tality. One  will  see,  however,  as  we  pro- 
ceed, that  all  evidence  points  to  the  fact 
that  cancer  is  not  a  purely  local  disease,  of 
totally  unknown  causation,  but  that  there 
are  deep  constitutional  causes,  based 
largely  on  some  of  the  baneful  influences 
of  civilization,  and  that  it  is  upon  the 
recognition  and  rectification  of  these  fac- 
tors that  the  true  prophylaxis  and  cure 
of  cancer  rest. 

Abundant  testimony  has  come  from  all 
over  the  world  that  cancer  is  very  rare 
among  aborigines,  living  simple,  mainly 
vegetarian,  lives,  some  of  which  evidence 


CANCER  AND  CIVILIZATION  279 

is  presented  in  the  volumes  referred  to, 
and  is  amply  shown  in  the  admirable 
treatise  by  Williams  on  the  ^^  Natural  His- 
tory of  Cancer/'  as  also  in  the  remark- 
able compilation  by  Hoffman,  on  **The 
Mortality  from  Cancer  throughout  the 
World. ' '  A  few  illustrations  may  be  given, 
largely  as  presented  by  Williams  and  Hoff- 
man, whose  intensive  studies  and  abundant 
references  to  literature  merit  close  atten- 
tion. 

In  Australia  cancer  is  everywhere  fairly  com- 
mon among  those  of  white  descent  .  .  .  but 
among  the  aborigines  it  is  so  rare  as  to  be  almost 
unknown.  In  New  Zealand  the  aborigines  are 
seldom  affected. 

It  seems  perfectly  clear  that  malignant  tumors 
are  of  much  rarer  occurrence  in  Africa  than  in 
any  other  of  the  great  di^^sions  of  the  world 
....  and  even  here  it  is  those  of  white  de- 
scent who  are  the  chief  sufferers,  for  the  natives 
are  seldom  affected. 

In  the  American  Continent  ....  this  mal- 
ady is  common  in  all  parts  of  British  North 
America,  except  among  the  aborigines. 

Among  the  North  American  Indians 
cancer  appears  to  be  extremely  rare,  and 


280  MEDICAL  ASPECTS  OF  CANCER 

one  careful  investigator  declares  that  they 
are  actually  nearly  immune  from  the  dis- 
ease. 

In  Mexico  and  the  Central  American  commu- 
nities cancer  is  decidedly  rarer  than  in  the 
United  States. 

The  negroes  in  the  United  States  were 
known  to  have  almost  no  cancer  while  liv- 
ing in  slavery,  when  the  food  and  mode 
of  life  were  simple.  But  the  statistical  re- 
ports since  the  Civil  War  show  a  steady 
increase  of  mortality  from  malignant  dis- 
ease among  them,  since  they  have  mingled 
with  whites  and  eaten  their  food,  with 
their  own  natural  tendency  to  gluttony 
and  idleness.  In  the  cities  this  is  most 
striking,  and  in  New  Orleans  the  rate  per 
100,000  for  negroes  in  1914  was  actually 
greater  than  that  of  whites. 

In  Australia  cancer  is  rare  among  the 
natives  in  the  interior,  but  when  they 
mingle  with  foreigners  as  servants  or  em- 
ployees, and  adopt  their  diet  and  customs, 
the  disease  appears  more  frequently  among 
them. 


CANCER  AND  CIVILIZATION  281 

The  Polynesians  and  Melanesians  seem 
to  be  peculiarly  exempt  from  cancer. 

In  India  all  writers  agree  that  cancer 
is  rare  among  the  inhabitants  of  warmer 
country  districts,  where  they  live  largely 
on  rice  or  millet,  with  a  little  milk,  and 
butter,  and  vegetables.  In  Ceylon  the 
death  rate  from  cancer  was  reported  as 
the  lowest  of  any  locality  in  Asia,  namely 
5.6  persons  for  100,000  population. 

During  a  rather  extensive  trip  through 
the  Far  East  I  was  unable  to  see  or  hear 
of  any  cancer,  although  I  met  a  large 
number  of  medical  men  and  made  diligent 
search  and  inquiry  for  the  same.  I  visited 
very  many  civil  military  and  mission  hos- 
pitals, with  a  total  of  many  thousands  of 
patients,  and  ministering  to  many  millions 
of  population;  in  Japan,  Korea,  China, 
the  Philippines,  India,  Siam,  and  Egypt  I 
met  with  the  same  response,  that  cancer 
was  rarely  seen  among  these  vegetarian 
natives. 

Let  us  now  briefly  sketch  the  steadily 


282  MEDICAL  ASPECTS  OF  CANCER 

increasing  death  rate  of  cancer  as  it  has 
been  recorded  in  connection  with  so-called 
advancing  civilization,  for  it  has  been  re- 
marked by  one  investigator  of  statistics 
that  **the  mortality  from  cancer  is  in  a 
direct  ratio  to  the  intensity  of  human 
civilization.'* 

England  has  long  furnished  the  most 
accurate  statistics  of  cancer,  as  of  other 
diseases.  In  1840  the  cancer  death  rate 
was  17.7  per  100,000  living,  which  rose 
steadily  until  in  1905  it  was  88.5  per 
100,000;  the  population  had  only  a  little 
more  than  doubled,  while  the  death  from 
cancer  had  increased  by  exactly  five  fold. 
In  1913  the  mortality  from  cancer  in 
England  and  Wales  was  94.7  per  100,000 
population,  and  in  London  it  was  114.9 
in  1913. 

Time  does  not  admit  of  the  full  presen- 
tation of  the  increase  of  cancer  deaths  in 
other  highly  civilized  countries,  which  is 
abundantly  shown  in  the  works  of  Wil- 
liams and  Hoffman   already  referred  to 


CANCER  AND  CIVILIZATION  283 

and  also  in  the  work  of  Wolff — Die  Lehre 
von  der  Krebskrankheit,  Jena,  1913,  et  seq,; 
but  a  few  points  may  be  mentioned. 

In  France,  cancer  mortality  in  1892  was 
88  and  in  1905  it  was  100.2  per  100,000  in- 
habitants. In  Paris  it  had  risen  from  97.2 
per  100,000  in  1881  to  112.4  in  1912. 

In  Germany,  deaths  from  cancer  in- 
creased from  53.5  in  1891  to  90  per  100,000 
living  in  1912.  In  Berlin,  the  increase  in 
the  cancer  death  rate  was  from  64.6  in  1881 
to  132.8  per  100,000  in  1912,  that  is,  had 
more  than  doubled  in  proportion  to  the 
living  inhabitants. 

In  Holland,  the  mortality  from  cancer 
rose  from  57.6  per  100,000  in  1881  to 
109.5  in  1913.  In  Amsterdam,  the  rise 
was  from  72.2  to  114.8  in  the  same  period. 

In  Belgium,  the  rise  in  the  mortality 
from  cancer  was  from  59.4  per  100,000 
population  in  1903  to  71.3  in  1912.  In  Ant- 
werp, it  was  from  47.6  in  1896  to  90.9  in 
1912;  in  Brussels,  it  was  from  88.2  per 
100,000  living  in  1901  to  106.2  in  1912. 


284  MEDICAL  ASPECTS  OF  CANCEE 

In  Italy,  the  death  rate  from  cancer  was 
21  per  100,000  population  in  1880,  and  in 
1912  it  was  64.7.  In  Eome,  it  had  risen 
from  79.1  in  1898  to  99.6  in  100,000  popu- 
lation in  1912. 

It  would  be  interesting,  did  time  permit, 
to  trace  the  death  rate  of  cancer  in  many 
other  localities,  to  show  the  relationship 
of  the  disease  to  some  of  the  elements 
which  go  to  make  up  what  is  called  mod- 
em civilization. 

Mention  has  been  made  of  the  steady  de- 
cline in  the  mortality  from  tuberculosis  in 
the  United  States,  and  it  is  most  interest- 
ing to  study  its  declining  mortality  in  many 
other  regions,  in  an  inverse  proportion  to 
the  rise  of  the  death  rate  from  cancer; 
for,  as  we  shall  see,  the  two  diseases  de- 
pend upon  two  opposite  conditions  of  nu- 
trition developed  coincidently  with  mod- 
ern civilization. 

Time  does  not  permit  of  the  presenta- 
tion of  the  evidence  which  has  been  so 
carefully  collected  by  Williams  and  Hoff- 


CANCER  AND  CIVILIZATION  285 

man  to  show  the  interrelation  of  tuber- 
culosis and  cancer  to  the  conditions  of 
life  in  various  localities,  but  a  careful 
study  of  the  statistics  Williams  gives  war- 
rants the  rather  remarkable  statement 
which  he  makes,  as  follows: 

Such  an  examination  shows  that  the  cancer 
mortality  is  the  lowest  where  the  struggle  for 
existence  is  the  hardest,  the  density  of  popula- 
tion greatest,  the  tubercle  mortality  highest,  the 
birth-rate  highest,  the  average  duration  of  life 
shortest,  the  infantile  and  general  mortality 
highest,  and  where  sanitation  is  least  perfect — in 
short,  among  the  poor  of  the  industrial  classes 
in  our  large  towns ;  whereas  among  the  wealthy 
and  well  to  do — where  the  standard  of  health  is 
at  its  best,  and  life  is  easiest,  and  all  conditions 
of  existence  are  just  the  reverse  of  the  foregoing, 
there  the  cancer  mortality  is  highest. 

These  are  strong  words  and  may  be 
contested  by  some,  but  a  very  careful 
study  of  the  facts  and  statistics  collected 
by  Williams  will  convince  the  impartial  stu- 
dent that  they  are  not  far  from  the  truth. 

All  are  familiar  with  the  clinical  history 
of  tuberculosis.  When  from  unsanitary 
surroundings,  poor  nourishment  and  over- 


286  MEDICAL  ASPECTS  OF  CANCER 

work,  with  deficient  oxygen  the  patient's 
health  fails,  there  comes  a  time  when  a 
focus  of  tuberculosis  is  discovered,  and 
unless  checked  by  a  reversal  of  the  con- 
ditions inducing  the  depression  of  health, 
the  disease  proves  fatal. 

With  cancer,  however,  the  clinical  his- 
tory is  quite  the  reverse.  The  subjects  of 
beginning  cancer  are  commonly  seen  to 
be  in  apparently  excellent  health;  they 
are  often  ruddy  and  blooming  in  appear- 
ance and  can  hardly  be  made  to  believe 
that  the  dire  disease  has  actually  begun 
in  them.  This  may  be  seen  even  in  re- 
gard to  cancer  of  internal  organs,  which 
is  often  first  suspected  and  recognized 
from  a  steady  departure  from  a  previous 
condition  of  excellent  and  robust  health. 

The  two  diseases  represent  exactly  two 
opposite  phases  of  nutrition,  both  induced 
by  the  artificial  conditions  of  existence 
pertaining  to  advanced  civilization.  In 
the  former  there  is  commonly  undernour- 
ishment with  overwork,  while  in  the  latter 


CANCER  AND  CIVILIZATION  287 

there  is  habitually  an  ovemourishment 
with  underwork.  In  the  period  from  1881- 
1890,  Dr.  Latham,  Register  General,  found 
the  death  rate  from  cancer  in  England  to 
be  more  than  twice  as  great  among  well- 
to-do  men  having  no  specific  occupation, 
as  among  occupied  males  in  general,  the 
mortality  ratios  being  96  for  the  former 
as  against  only  about  44  for  the  latter. 

If  time  permitted,  a  mass  of  evidence 
could  be  adduced  to  show  that  cancer  is  a 
disease  of  **hypernutrition**  as  Williams 
remarks.  This  does  not  mean  that  normal 
nutrition  can  be  overdone  if  all  the  con- 
tributing elements  are  correct.  But  the 
complex  of  modem  civilization,  with  all 
its  temptations  and  errors  in  regard  to 
eating  and  drinking,  and  living,  together 
with  the  nervous  strain  felt  everywhere, 
and  the  absence  of  sufficient  physical  ex- 
ercise, has  produced  such  a  disturbance 
in  the  normal  metabolism  and  nutrition, 
that  under  some  slight  provocation  a  het- 
erologous growth  of  certain  tissue  cells 


288  MEDICAL  ASPECTS  OF  CANCER 

results,  with  malignant  tendencies,  in- 
stead of  the  normal,  homologous,  and 
stabile  structures  which  compose  healthy 
tissues;  and  this  departure  form  normal 
cell  action  we  call  cancer. 

This  is  not  the  time  or  place  to  develop 
the  biochemic  changes  associated  with  can- 
cer which  have  been  abundantly  demon- 
strated, and  which  confirm  the  views  ex- 
pressed. These  have  been  presented  more 
or  less  fully  elsewhere.  The  fact  remains 
that  while  cancer  is  very  infrequent 
among  primitive  people  and  among  ani- 
mals living  in  a  state  of  nature,  it  has 
been  shown  to  increase  very  steadily  in 
morbidity  and  mortality  mth  the  inten- 
sity of  human  civilization,  and  also  among 
animals  as  they  become  domesticated. 
There  can,  therefore,  be  hardly  any  other 
conclusion  than  that  this  dire  disease  de- 
pends largely  upon  the  conditions  de- 
veloped by  or  associated  with  our  artifi- 
cial existence,  to  which  is  given  the  name 
of  ** modem  civilization.*' 


CHAPTER  XV 

CARCINOMA  OF  THE  BUCCAL  CAVITY.* 

Carcinoma  is  a  malignant  disease  af- 
fecting epithelial  structures.  Sarcoma  is 
one  affecting  connective  tissue  cells.  Both 
are  commonly  called  cancer,  and  both  oc- 
cur in  the  oral  cavity,  although  the  epi- 
thelial disease  is  many  more  times  fre- 
quent than  the  latter.  It  will  be  best  to 
consider  them  separately,  speaking  first 
of  epithelial  carcinoma.  It  is  especially 
in  regard  to  this  that  dentists  or  oral  sur- 
geons have  a  great  responsibility,  for  they 
of  all  others  are  most  apt  to  see  the  dis- 
ease in  its  inception;  and  if  entirely  neg- 
lected or  wrongly  treated,  as  with  ni- 
trate of  silver,  the  chances  of  an  ultimate 


*  Read  before  the  Harlem  Dental  Society,  October 
17,  1918. 

289 


290  MEDICAL  ASPECTS  OF  CANCER 

recovery  are  immeasurably  diminished. 
For  all  agree  that  the  end  results  of  oral 
cancer  are  very  discouraging,  the  disease 
usually  recurring  after  surgical  removal 
and  ending  the  life  of  the  patient  with 
much  misery,  except  in  cancer  of  the  lip 
when  removed  very  early  and  well. 

According  to  the  Mortality  Statistics  of 
the  United  States  there  were  somewhat 
fewer  deaths  from  cancer  of  the  oral 
^'avity  in  1916  than  when  I  reported  them 
for  1914.  In  1914  there  were  2270  deaths 
of  this  class,  or  4.3  per  cent  of  the  total 
deaths  from  cancer.  In  1916  there  were 
2091  deaths  or  3.6  per  cent  of  the  total 
of  58,000  deaths  from  cancer  in  the  regis- 
tration area.  There  was,  therefore,  a  dim- 
inution of  178  deaths,  or  nearly  8  per 
cent,  from  cancer  of  the  oral  cavity,  in 
spite  of  a  rise  of  the  deaths  from  cancer 
in  general.  It  is  to  be  hoped  that  this 
diminution  in  mortality  was  due  to  the 
prevalence  of  more  rational  views  in  re- 
gard to  the  disease:  it  certainly  could  not 


CANCER  OF  BUCCAL  CAVITY  291 

be  due  to  more  active  surgery,  under  wMch 
the  mortality  of  cancer  in  general  has 
risen  nearly  30  per  cent,  since  1900,  ac- 
cording to  the  United  States  Mortality 
Reports. 

Of  these  2091  deaths  from  cancer  of 
the  buccal  cavity,  or  2.9  persons  per 
100,000  of  the  population,  1730  or  82.75 
per  cent,  were  males  and  361  or  17.25 
females;  the  males  were  therefore  almost 
five  times  the  number  of  females.  The 
locations  of  the  disease  are  given  as  fol- 
lows: cancer  of  the  lip  374,  tongue  534, 
mouth  214,  jaw  796,  others  of  this  class 
173. 

It  may  be  interesting  to  note  that  in 
the  United  States  registration  area  the 
mortality  from  this  class  of  cases  has 
increased  more  than  from  cancer  in  any 
other  locality.  Thus  in  1916  it  was  2.9 
per  100,000  against  1.6  in  1900,  or  81.3 
per  cent,  increase,  while  the  general  in- 
crease in  cancer  mortality  has  been  30 
per  cent.  It  is  now  pretty  clearly  recog- 


292  MEDICAL  ASPECTS  OF  CANCER 

nized  that  of  all  those  affected  with  can- 
cer, in  various  regions,  about  90  per  cent, 
die  from  the  disease. 

The  early  recognition  of  cancer  of  the 
buccal  cavity  is  not  always  easy,  even 
to  the  expert.  But  one  should  always  re- 
member the  possibilities  and  seriously 
consider  even  small  lesions  in  this  locality, 
for  what  appears  to  be  an  innocent  mucous 
irritation  may,  under  proper  conditions  of 
the  system,  end  in  a  most  malignant  and 
serious  disease.  There  is  not  time,  nor  is 
this  the  occasion  to  discuss  what  these  con- 
ditions of  deranged  metabolism  are  which 
induce  cancer;  they  have  been  fully  pre- 
sented elsewhere.  All  are  aware  of  the  re- 
markable healing  powers  of  the  tissues  of 
the  mouth,  as  after  extraction  of  teeth,  ac- 
cidental injuries,  and  various  operations, 
in  spite  of  the  great  numbers  of  various 
micro-organisms  found  therein,  and  it 
seems  strange  that  its  tissues  should  ever 
take  on  such  malignant  action  as  may 
occur.    This  certainly  points  to  some  con- 


CANCER  OF  BUCCAL  CAVITY  293 

stitutional  alteration  of  the  blood  which 
favors  this  morbid  departure  from  normal 
cell  action. 

Suffice  to  realize  that  cancer  has  its 
starting  point  in  cells  which  have  been 
previously  healthy,  and  that  long  con- 
tinued irritation  is  the  local  cause  of  the 
development  of  the  disease  in  some  par- 
ticular locality.  Especial  care  should  there- 
fore be  given  to  any  lesion  which  has  per- 
sisted for  some  time,  and  when  in  doubt 
as  to  the  nature  of  the  sore  skilled  ad- 
vice should  be  sought.  Cancer  is  not  an 
entity,  a  something  which  has  been  in- 
troduced from  outside,  an  infection;  it  is 
not  infectious  or  contagious  at  any  stage, 
for  no  surgeon,  nurse,  or  pathologist  in 
contact  with  cancerous  tissues  has  ever 
been  infected,  and  laboratory  experiments 
have  always  failed  to  inoculate  human 
cancer.  Cancer  is  simply  a  disordered  ac- 
tion of  originally  normal  or  healthy  cells, 
which  continue  to  act  in  a  disordered  man- 
ner, increasing  steadily,   exercising  their 


294  MEDICAL  ASPECTS  OF  CANCER 

malignant  influence  on  surrounding  tis- 
sues, and,  unless  checked,  producing  a  hor- 
mone, or  something,  which  ultimately  de- 
vitalizes the  blood  and  causes  death. 

During  its  various  stages  epithelial  can- 
cer in  the  oral  cavity  presents  quite  differ- 
ent appearances.  In  its  earliest  phases  it  is 
nothing  but  an  eroded  surface,  non-in- 
flammatory, discharging  but  little,  and 
with  rather  sharp  margins.  As  it  pro- 
gresses the  edges  harden,  and  there  is 
some  superficial  ulceration.  Later  it  at- 
tacks deeper  tissues,  spreading  also  periph- 
erally and  ulcerates  more,  and  the  ad- 
joining glands  beneath  the  jaw  are  en- 
larged. In  early  stages  there  may  be  little 
or  no  discomfort,  but  as  the  disease  pro- 
gresses there  is  lancinating  pain  and  ir- 
ritation from  food.  Later  the  pain  may  be 
more  distressing,  while  in  recurrent  cases, 
after  surgical  operation  the  pain  and 
agony  become  unbearable  and  the  condi- 
tion of  the  patient  most  pitiable,  until 
death  ends  the  scene. 


CANCER  OF  BUCCAL  CAVITY  295 

There  are  a  number  of  diseases  whose 
lesions  appear  in  the  mouth,  which  are  to 
be  differentiated  from   epithelial   cancer. 

1.  Aphthous  stomatitis,  or  canker  sores, 
are  perhaps  the  most  common  lesions 
found  in  the  mouth,  and  may  be  impor- 
tant as  the  possible  starting  point  of  can- 
cer, especially  if  they  are  ^* touched  up'' 
with  nitrate  of  silver,  as  is  so  commonly 
done,  but  which  should  never  be  done. 
They  are  the  result  of  disordered  diges- 
tion, and  some  persons  have  repeated  at- 
tacks with  each  recurrent  stomach  de- 
rangement. They  are  commonly  multiple, 
round  or  oval,  inflammatory  in  character 
with  superficial  ulceration,  appearing  sud- 
denly with  some  little  soreness.  They 
usually  disappear  soon  after  the  patient 
is  placed  under  proper  digestive  treat- 
ment, with  a  mild  mouth  wash  of  bicar- 
bonate of  soda  and  frequent  touching  of 
the  spots  with  burnt  alum  powder,  ap- 
plied with  moistened  finger.  If  one  or 
more  of  them  persist  it  is  always  well  to 


296  MEDICAL  ASPECTS  OF  CANCER 

consider  the  possibility  of  its  being  the 
beginning  of  a  true  cancer. 

2.  Simple  ulceration  of  the  tongue  or 
buccal  cavity  should  always  receive  care- 
ful attention,  and  if  persistent  should  be 
regarded  with  suspicion  as  a  possible 
antecedent  of  cancer.  This  may  be  caused 
by  broken,  rough  or  decayed  teeth  which 
of  course  should  be  most  carefully  at- 
tended to  by  the  dentist.  Sometimes  they 
are  caused  by  ill-fitting  or  rough  plates, 
and  in  certain  instances  I  have  believed 
that  a  red  rubber  plate  has  been  the 
cause,  when  the  trouble  has  ceased  after  a 
black  rubber  or  gold  plate  has  been  sub- 
stituted. Tobacco  often  plays  an  impor- 
tant part,  as  it  has  been  often  shown  that 
smoking,  especially  of  a  pipe,  is  largely 
responsible  for  the  occurrence  of  cancer 
of  the  lip.  Alcohol  may  also  have  a  share. 
Some  such  causes  for  the  local  appear- 
ance of  cancer  in  the  mouth  seem  prob- 
able from  the  fact  mentioned  that  nearly 
five  times  as  many  men  as  women  die 


CANCER  OF  BUCCAL  CAVITY  297 

from  oral  cancer.  In  the  East,  where  the 
practice  of  chewing  a  mass  composed  of  be- 
tel leaves,  tobacco,  and  lime  is  customary, 
by  men  and  women,  these  malignant  lesions 
are  seen  in  the  mouth  of  both  sexes. 

3.  Syphilis.  Syphilis  is  a  great  disease 
with  many  manifestations,  and  mouth 
lesions  are  not  uncommon  at  some  period 
of  its  course.  These  are  sometimes  diffi- 
cult of  absolute  diagnosis,  though  the 
Wassermann  blood  test  may  often  be  of 
great  help.  It  is  hardly  possible  here  to 
go  over  the  whole  ground  of  differential 
diagnosis,  but  some  suggestions  may  be 
of  value.  Syphilis  may  appear  in  the 
mouth  as  the  primary  lesion,  or  chancre, 
mucous  patches,  and  late  gununy  lesions. 

The  primary  sore,  the  seat  of  infection, 
according  to  large  statistics,  occurs  extra- 
genitally,  generally  in  an  innocent  man- 
ner, in  something  over  5  per  cent,  of  all 
cases  of  syphilis.  Of  these  a  very  con- 
siderable proportion  occur  about  the 
mouth,  quite  sufficient  to  make  it  an  ob- 


298  MEDICAL  ASPECTS  OF  CANCER 

ject  of  interest,  in  this  connection,  and 
should  never  be  forgotten.  In  a  study  of 
extra-genital  chancre/  I  was  able  to  col- 
lect from  literature,  9058  cases  of  which 
1810  were  on  the  lip,  and  1544  within  the 
mouth,  making  a  total  of  3354  chancres 
in  this  region,  or  36.6  per  cent,  of  all 
cases.  Of  the  oral  cases  734  are  record- 
ed as  in  the  buccal  cavity,  307  on  the  ton- 
sils, 264  in  the  throat,  157  on  the  tongue, 
and  42  on  the  gums,  a  considerable  num- 
ber of  which  were  attributed  to  infection 
through  dental  work  or  instruments.  The 
dentist  should  never  forget  the  danger  of 
syphilitic  infection  of  himself  or  patients 
when  unusual  lesions  are  found  on  the 
mucous  membranes. 

The  chancre  begins  as  a  small  abrasion 
which  soon  hardens  and  remains  many 
weeks,  giving  off  a  glairy  mucous  secre- 
tion, which,  of  course,  is  very  contagious. 
As  stated,  over  one-half  of  the  cases  oe- 


^Bulkley:      Syphilis   in   the   Innocent.     New   York, 
1894. 


CANCER  OF  BUCCAL  CAVITY  299 

cur  on  the  lips,  generally  the  lower,  as  a 
button-like  lesion  which  is  sometimes  mis- 
taken for  cancer  and  excised. 

Mucous  patches  are  the  principle  source 
of  danger  of  infection.  These  are  flat, 
superficial,  rather  pearly  white,  mucous 
lesions,  of  which  there  are  generally  sev- 
eral, commonly  sharply  defined  and  giv- 
ing off  a  sticky  secretion.  In  the  early 
stages  of  syphilis  they  are  intensely  con- 
tagious and  are  the  cause  of  most  of  the 
cases  of  syphilitic  infection,  both  genital 
and  extra-genital,  a  chancre  developing  in 
the  site  of  inoculation.  Mucous  patches 
may  appear  at  any  period  of  syphilis, 
but  in  the  very  late  stages  they  are  less 
contagious. 

The  late  gummy  lesions  of  syphilis,  es- 
pecially on  the  tongue  often  resemble  ad- 
vanced cancer  very  closely,  and  indeed  are 
occasionally  the  starting-point  of  true  can- 
cer. They  are  very  slightly,  if  at  all,  con- 
tagious. 

4.    Leucoplakia.      This    consists    of    a 


300  MEDICAL  ASPECTS  OF  CANCER 

rather  pearly  white,  often  streaked  con- 
dition of  the  mucous  membrane,  commonly 
on  the  inside  of  the  cheeks  and  tongue 
which  is  most  rebellious  to  treatment,  and 
commonly  persists  a  long  time;  it  is  to  be 
distinguished  from  mucous  patches  and 
is  not  at  all  contagious.  It  is  relatively 
rarely  seen  in  females,  and  it  is  commonly 
regarded  as  caused  by  tobacco ;  but  it  also 
occurs  in  those  who  have  never  used  the 
weed.  It  should  never  be  *^ touched  up'* 
with  nitrate  of  silver,  as  this  may  goad  a 
relative  innocent  affection  into  cancer. 
The  main  interest  of  the  dentist  in  this 
disease  is  that  it  is  claimed  to  be  a  pre- 
cursor of  cancer,  and  any  ulcerative 
change  in  it  should  always  be  regarded 
seriously,  and  the  dentist  may  often  be 
the  first  to  give  the  warning. 

5.  Tubercular  lesions  or  Lupus  occa- 
sionally resemble  cancer  in  the  buccal 
cavity,  but  they  are  very  rare.  They  oc- 
cur on  the  tongue  and  gums,  and  consist 
of  rather  soft,  pulpy  tissue,  a  little  darker 


CANCER  OF  BUCCAL  CAVITY  301 

than  normal,  which  bleed  rather  easily, 
and  do  not  harden  up  like  cancer. 

On  the  lips  the  dentist  may  frequently 
see  lesions  which  may  be  precursors  of 
cancer,  and  they  may  be  the  first  to  give 
warning.  Prolonged  fissure  of  the  lip  is 
always  significant,  and  cannot  be  too  care- 
fully guarded.  Any  persistent  ulceration, 
from  biting  the  lips,  smoking,  or  even 
after  a  ^^fever  blister,'*  should  always  be 
regarded  seriously. 

Sarcoma,  This  differs  in  many  re- 
spects from  the  epithelial  disease  just 
described,  or  epithelial  cancer,  although  it 
also  passes  under  the  name  of  cancer. 
Although  sarcoma  is  much  less  frequent 
than  carcinoma,  it  is  of  interest  to  the 
dentist  who  may  often  be  consulted  about 
it  before  it  is  seen  by  the  surgeon.  It  is 
a  deep-seated  disease,  affecting  mainly 
the  upper  and  lower  jaw,  and  the  dentist 
may  be  first  consulted  on  account  of  the 
deep-seated  pain,  supposedly  from  the 
teeth.    These  are  extracted  but  the  pain 


302  MEDICAL  ASPECTS  OF  CANCER 

continues  and  the  gnm  becomes  swollen 
and  red.  Presently  a  tolerably  definite 
mms  is  foimed,  often  at  the  site  of  ex- 
traction, which  is  hard  on  deep  pressure, 
but  with  swollen,  purplish  gum  tissue 
over  it.  Sometimes  the  tumor  first  ap- 
pears at  the  side  of  the  lower  jaw.  In 
the  upper  jaw  it  often  starts  in  the  an- 
trum of  Highmore,  and  is  not  seen  in  the 
mouth  until  there  has  been  a  considerable 
growth,  even  pressing  in  the  vault.  Sar- 
coma has  none  of  the  early  characteristics 
of  epithelioma,  as  previously  described. 
It  occurs  far  more  frequently  in  the  young 
than  in  the  old,  the  reverse  of  carcinoma. 
Malignant  disease,  carcinoma  and  sar- 
coma, is  in  general  much  more  prevalent  in 
older  than  younger  persons;  according  to 
the  United  States  Mortality  Statistics 
there  were  but  29  deaths,  16  males,  and 
13  females,  below  the  age  of  25,  out  of 
a  total  of  2091  deaths  from  cancer  in 
this  locality.  After  25  years  of  age  the 
number   rises    steadily  and   rapidly,   and 


CANCEE  OF  BUCCAL  CAVITY  303 

the  deaths  are  singularly  equal  in  each 
of  the  ^ve  years  from  55  to  74,  namely 
263,  282,  278,  269,  a  total  of  1091  deaths, 
or  over  half  the  total  number  in  these 
twenty  years  of  life  against  29  in  the 
first  25  years. 

Carcinoma  of  the  buccal  cavity  is  a 
most  important  subject,  and  it  is  well 
for  dentists  to  bear  it  constantly  in  mind, 
for  the  sake  of  suffering  humanity. 
Their  work  lies  mainly  along  the  line  of 
prevention,  for  when  far  advanced  it  is 
practically  hopeless,  almost  constantly  re- 
curring in  an  even  more  terrible  form. 
Rarely  do  I  consent  to  a  surgical  opera- 
tion within  the  mouth,  though  in  early 
cancer  of  the  lip  a  very  radical  and  per- 
fect operation  may  be  successful.  Radi- 
um has  proved  of  value  in  some  cases, 
even  within  the  mouth,  but  a  proper  and 
perfectly  carried  out  medical  treatment 
I  am  confident,  from  experience,  yields 
infinitely  better  results  than  surgery.  It 
is  never  safe  to  excise  a  portion  for  mi- 


304  MEDICAL  ASPECTS  OF  CANCER 

croscopic  examination,  as  this  most  cer- 
tainly leads  to  wide  infection  and  dimin- 
ishes greatly  the  possible  chances  of  any 
advantage  from  a  later  radical  operation, 
or  of  the  success  of  medical  treatment. 

This  is  not  the  place  to  dwell  on  the 
treatment  of  carcinoma  of  the  oral  cavity, 
for  I  do  not  suppose  that  you  undertake 
such  cases.  But  a  few  words  may  be 
said  in  regard  to  the  part  the  dentist  may 
play  in  averting  this  dire  disease. 

As  has  been  intimated,  some  of  the 
main  exciting  causes  or  oral  cancer  arise 
from  irritating,  broken,  or  decayed  teeth, 
and  also  from  ill-fitting  plates.  It  be- 
hooves the  dentist,  therefore,  to  search 
for  these  and  to  remedy  them  effectively. 
In  the  case  of  prolonged  irritation  or  ul- 
ceration of  the  mucous  membrane  good 
warning  should  be  given  the  patient  not 
to  neglect  it,  but  to  seek  and  follow  at 
once  the  proper  advice. 

In  what  has  been  said  a  warning  has 
been  given  against  the  employment  of  ni- 


CANCER  OF  BUCCAL  CAVITY  305 

trate  of  silver  within  the  mouth,  or  to 
epithelioma  anywhere.  I  cannot  urge  this 
too  seriously,  for  by  its  injudicious  ap- 
plication lesions  which  originally  were 
quite  innocent,  or  would  remain  harmless, 
may  easily  be  goaded  on  to  take  on  malig- 
nant action,  in  systems  predisposed  there- 
to. Nitrate  of  silver  cannot  cure  them, 
and  I  regard  its  use  as  an  almost  criminal 
procedure.  All  stimulation  should  be 
carefully  avoided,  and  all  sources  of  ir- 
ritation should  be  removed.  Carcinoma 
is  known  to  develop  under  conditions  of 
acidity,  as  in  the  stomach,  large  intestines 
and  urinary  bladder,  and  the  saliva  is 
generally  found  to  be  acid  in  these  cases, 
and  often  excessively  and  persistently  so. 
Only  mild  mouth  washes  should  be  em- 
ployed, and  of  these  a  fairly  strong  solu- 
tion of  bicarbonate  is  about  the  best, 
soaking  the  mouth  freely  with  it  half  an 
hour  before  and  soon  after  eating. 

It  is  difficult  to  cover  so  large  a  sub- 
ject as  cancer  of  the  oral  cavity  in  a 


306  MEDICAL  ASPECTS  OF  CANCER 

single  address,  but  I  trust  that  enough 
has  been  said  to  invite  discussion  and  to 
lead  to  more  observation,  thought,  and 
study  on  the  subject.  If  one  could  know 
and  see  some  of  the  frightful  ravages  in 
late  and  recurrent  cases  of  this  disease, 
which  caused  the  death  of  over  2000  per- 
sons in  the  United  States  during  the  year, 
surely  every  endeavor  would  be  made,  by 
everyone  who  had  the  opportunity,  to 
lessen  this  suffering  and  mortality.  As 
the  profession  and  the  public  become  edu- 
cated as  to  its  predisposing  and  exciting 
causes,  it  is  certain  that  this  morbidity 
and  mortality  will  decrease,  even  as  the 
deaths  from  tuberculosis  have  declined 
ahnost  30  per  cent,  from  1900  to  1916 
under  careful  medical  supervision;  while 
those  from  cancer  have  risen  almost  30 
per  cent.,  during  the  same  time,  under 
the  care  which  has  heretofore  been  given. 
And  I  am  confident  that  the  dentists  can 
contribute  no  inconsiderable  share  in 
bringing  about  this  most  desirable  result. 


CHAPTEE  XVI 

WHAT  SHOULD  THE  MEDICAL  PRACTITIONER  DO 
ABOUT  CANCER?  * 

The  answer  to  the  question,  **What 
should  the  medical  practitioner  do  about 
cancer  r'  in  accordance  with  modern  cus- 
tom, seems  plain,  namely,  '*  Leave  it  to 
the  surgeon."  But  why,  and  is  this 
really  the  correct  thing  to  do!  Or,  shall 
the  disease  be  left  to  the  advertising 
quacks  ? 

It  is  now  pretty  generally  believed  by 
the  medical  profession  and  the  laity  that 
surgery  offers  the  only  hope  in  cancer. 
However,  I  hope  to  show  that  real  cancer, 
other  than  epithelioma  of  the  skin — on 
which  latter  so  many  of  the  arguments 
for  surgery  are  based — is  a  medical  rath- 


*  Read  before  the  Litchfield  County    (Connecticut) 
Medical  Society,  July  3,  1917. 

307 


308  MEDICAL  ASPECTS  OF  CANCER 

er  than  a  surgical  disease,  and  that  with 
proper  and  prolonged  dietary  and  medi- 
cal treatment  the  results  are  far  better 
than  from  surgical  intervention.  Careful 
medical  attention  must  be  given  to  the 
disease  if  we  ever  hope  to  diminish  the 
distressing  increase  in  its  morbidity  and 
mortality,  as  I  have  many  times  tried  to 
show. 

The  reasons  why  the  medical  profession 
and  the  laity  have  so  universally  accepted 
the  dictum  that  cancer  belongs  to  the  do- 
main of  surgery  are  not  difficult  to  dis- 
cern. 

The  medical  profession,  being  occupied 
largely  with  acute  disease,  with  apparent- 
ly definite  and  speedy  results,  very  natur- 
ally became  discouraged  by  the  unsatis- 
factory course  commonly  observed  in  can- 
cer; as  was  the  case  in  regard  to  tubercu- 
losis, until  the  revival  of  interest  in  the 
latter  in  recent  years,  with  the  well-known 
beneficial  consequences,  to  be  considered 
later. 


CANCER  IN  GENERAL  PRACTICE  309 

Then  the  surgeons  took  up  the  treat- 
ment of  cancer,  and,  as  the  wounds  gener- 
ally healed  well  after  excision  and  the 
immediate  results  of  the  operation  seemed 
favorable,  little  thought  seems  to  have 
been  given  to  the  constant  recurrence  in 
subsequent  years,  for  unfavorable  statis- 
tics are  seldom  published. 

By  the  brilliant  advances  in  modem 
surgery  along  many  lines,  the  laity  have 
become  so  obsessed  by  the  idea  that  in 
many  directions  its  possibilities  are  limit- 
less that  the  cancer-patients  have  con- 
stantly yielded  themselves  to  the  knife,  in 
the  face  of  the  steadily  rising  mortality 
of  late  years.  The  glamor  of  surgery  aud 
its  often  spectacular  results  have  quite 
blinded  the  eyes  of  many  to  the  real  facts. 

The  enormous  accomplishments  with  the 
microscope  with  reference  to  the  minute 
structure  of  the  diseased  tissues,  and  the 
elaborate  and  extensive  work  done  in  ani- 
mal experimentation,  together  with  the 
expressed    opinion    of    many    laboratory- 


310  MEDICAL  ASPECTS  OF  CANCER 

workers  that  cancer  is  a  local  disease,  only 
requiring  early  extirpation,  have  turned 
the  thoughts  of  many  away  from  the 
homely  and  practical  studies  of  the  human 
frame  in  its  various  departures  from 
health.  In  this  way,  relatively  little  at- 
tention has  been  given  to  its  biochemistry 
and  the  deranged  activities  of  the  various 
organs.  We  have  also  studied  too  little 
the  perverted  metabolism  resulting  from 
the  stress  and  strain  of  modern  life,  to- 
gether with  the  temptations  as  to  eating 
and  drinking  that  accompany  the  existing 
intensity  of  present-day  civilization. 

Cancer  being  left  to  the  surgeons,  it  is 
hardly  to  be  expected  that  they  would  in- 
cline to  any  other  treatment  than  that 
with  the  knife.  Nor  would  one  expect 
that  the  surgeon  would  think  along  medi- 
cal lines  and  investigate  metabolic  condi- 
tions, when  the  immediate  results  of  opera- 
tions seem,  often,  to  be  so  satisfactory. 
Neither  would  one  expect  the  surgeon  to 
seek  from  statistics  the  unfavorable  as- 


CANCER  IN  GENERAL  PRACTICE  311 

pects  of  this  line  of  treatment,  but  rather, 
those  from  which  he  would  draw  encour- 
agement in  trying  to  overcome  so  dire  a 
disease. 

It  is  to  be  observed,  however,  that  of 
late  years  even  the  surgeons  have  ex- 
tended the  time  after  which  cancer  can 
be  said  to  be  cured,  from  a  former  two 
years  limit,  to  three,  five  or  more  years, 
while  some  are  candid  enough  to  say  that 
no  definite  period  can  be  set,  for  often 
recurrences  have  been  observed  ten,  fif- 
teen or  twenty  years  after  surgical  re- 
moval. This  agrees  with  the  more  ra- 
tional view  of  regarding  cancer  as  a  con- 
stitutional metabolic  disease,  which  may 
manifest  itself  anywhere  and  at  any  time, 
whenever  the  systemic  conditions  of  the 
individual  are  suitable  for  a  new  develop- 
ment of  the  malignant  new  growth  to  be 
generated. 

What,  then,  should  the  general  practi- 
tioner do  with  reference  to  cancer? 

Let  us  look  for  a  moment  as  to  what 


312  MEDICAL  ASPECTS  OF  CANCER 

proper  medical,  dietary,  and  hygienic 
treatment  has  done  for  tuberculosis,  de- 
spite the  persistence  of  tubercle-bacilli  in 
affected  subjects.  In  1900,  in  the  regis- 
tration area  of  the  United  States,  201.9 
persons  out  of  each  100,000  population 
died  of  tuberculosis.  In  1916,  under  care- 
ful medical  guidance,  the  number  of  these 
deaths  had  fallen  to  141.6,  or  a  decrease 
of  60.3  persons  per  100,000;  in  other 
words,  29.86,  or  almost  30  per  cent. 

Now,  during  the  same  period,  the  re- 
corded deaths  from  cancer  had  risen, 
under  active  surgical  care,  from  63  per 
100,000  population,  to  81.8,  or  29.84  per 
cent. — almost  exactly  the  same  percentage 
that  deaths  from  tuberculosis  had  fallen. 
Thus  the  death  rates  of  the  two  diseases 
have  approached  each  other  with  an  amaz- 
ing regularity  almost  60  per  cent.,  so  that 
while  in  1900  they  were  139.9  points  apart, 
in  1916,  they  were  only  59.8  points  apart ; 
at  this  rate  of  increase  of  cancer  deaths 
and  decrease  in  deaths  from  tuberculosis, 


CANCER  IN  GENERAL  PRACTICE  313 

the  former  will  soon  claim  more  victims 
per  100,000  population  than  the  latter. 

It  may  be  interesting  here  to  mention 
the  latest  information  in  regard  to  the 
cancer  death  rate  in  New  York  City,  as 
obtained  by  a  study  of  the  actual  figures 
furnished  by  the  local  board  of  health  in 
its  weekly  reports.  During  1917,  there 
were  4,859  deaths  recorded  from  cancer 
in  New  York  City  (2,143  males  and  2,716 
females).  This  total  number  divided  by 
365  days  gives  an  average  of  13.31  per- 
sons dying  daily  from  this  cause  in  New 
York  City !  During  1916,  there  were  4,635 
deaths  from  cancer,  or,  an  average  of 
12.68  persons  per  day.  Further:  in  the 
year  1917,  there  was  a  total  of  78,467 
deaths  from  all  causes  in  Greater  New 
York,  against  77,948  in  1916 — an  increase 
of  516,  or  less  than  one  per  cent. — whereas 
the  increase  of  cancer  deaths  was  224,  or 
over  four  and  one-half  (4.5)  per  cent. 

What,  then,  I  again  ask,  should  the  gen- 
eral practitioner  do  in  regard  to  cancer? 


314  MEDICAL  ASPECTS  OF  CANCER 

Evidently,  he  should  not  pursue  a  plan 
of  treatment  that  shows  a  steadily  increas- 
ing mortality,  so  that  now  it  is  about 
agreed  that  90  per  cent,  of  those  once  af- 
fected with  cancer  die  from  it!  This 
would  not  be  tolerated  in  any  other  dis- 
ease. 

It  is  high  time,  indeed,  for  the  medical 
man  to  take  up  earnestly  the  study  of 
cancer  in  its  medical  relations  and  to  seek 
to  understand  its  cause  and  to  seek  to 
rectify  the  systemic  errors  that  lead  to  the 
formation  of  heterologous,  malignant  tis- 
sue, or  tumors,  instead  of  to  the  homolo- 
gous tissues  of  health. 

The  limits  of  this  article  do  not  allow 
of  a  discussion  of  the  real  nature  and 
cause  of  cancer  and  its  medical  treatment, 
which  have  been  pretty  fully  presented 
elsewhere,  but  a  few  practical  sugges- 
tions may  not  be  out  of  place. 

All  nutrition,  good  and  bad,  comes  from 
the  food  and  drink  taken.  Under  normal 
conditions,  the  cells  of  the  various  tissues 


CANCER  IN  GENERAL  PRACTICE  315 

of  the  body  are  continually  subjected  to 
cataholism,  **a  breaking  down  of  complex 
bodies  of  living  matter  into  waste  prod- 
ucts of  simple  chemical  composition/' 
and  anaholism^  or  **the  process  of  assimi- 
lation of  nutritive  matter  and  its  conver- 
sion into  living  substance/'  these  together 
constituting  metabolism.  In  effecting  these 
metabolic  changes  in  the  system,  the  vari- 
ous secretory  and  excretory  organs  of  the 
body,  including  the  ductless  glands,  each 
perform  a  certain  part,  and  in  health  the 
final  results  are  carried  off  by  the  lungs, 
kidneys,  bowels,  and  skin,  in  an  orderly 
manner. 

In  various  chronic  disorders  of  the  sys- 
tem, from  different  causes,  including  er- 
rors in  eating  and  drinking,  there  is  some 
disturbance  in  the  operation  of  some  of 
the  organs,  with  an  altered  blood  current, 
and  there  result  various  derangements  in 
the  tissues,  to  which  derangements  we 
apply,  respectively,  the  names  of  different 
diseases,  one  of  these  being  cancer. 


316  MEDICAL  ASPECTS  OF  CANCER 

Cancer  is  simply  the  misgrowth  of 
epitheliat  cells,  such  as  had  previously 
been  normally  produced — as  all  patholo- 
gists agree.  Microscopic  studies  have 
demonstrated  that  within  the  cells  the 
earliest  cancer-genetic  change  is  found  in  a 
certain  disturbance  in  the  polarity  of 
the  cells;  also  in  the  relation  of  the 
centrosome  to  the  nucleus,  whereby  the 
cells  multiply,  by  a  deranged  karyokinesis, 
in  an  irregular,  luxurious,  and  riotous 
manner,  this  resulting  in  what  is  known  as 
cancer. 

Why  or  just  when  certain  cells  begin  to 
take  on  this  heterologous  action  has  not 
been  determined :  for  no  one  has  ever  seen 
and  recognized  the  very  beginnings  of  the 
malignant  process  in  true,  internal  cancer, 
any  more  than  has  been  seen  and  recog- 
nized the  first  inflammatory  change  in 
the  tissue  of  the  gouty  toe,  and  the  like. 
Suffice  to  say  that  there  must  be  a  cause; 
and  this  has  been  well  defined  as  a  sub- 
catabolism,   induced    by   hyperacidity    or 


CANCER  IN  GENERAL  PRACTICE  317 

oxydase  deficiency  in  the  surrounding  me- 
dium or  blood  plasma,  especially  through 
the  agency  of  the  myeloid  leukocytes, 
which  contain  a  ferment  of  the  oxydase 
variety. 

All  this  speculation,  though,  and  much 
more  that  has  been  advanced,  really  helps 
us  very  little  in  explaining  the  true  patho- 
genesis of  cancer ;  still,  it  has  its  practical 
bearing  with  regard  to  the  prophylaxis 
and  treatment  of  the  disease.  For  oxy- 
dase has  the  property  of  deamidizing,  that 
is,  destrojdng  amidoacids,  or  the  nitrog- 
enous elements,  which  have  been  found 
by  many  observers  to  be  at  fault  in  can- 
cer patients. 

This  leads  us  to  the  subject  of  the  in- 
fluence of  the  nitrogenous  diet  in  the  pro- 
duction of  cancer,  which  I  have  previ- 
ously shown,  statistically,  clinically,  ex- 
perimentally, and  analytically,  to  be  a  pre- 
dominating element  in  the  causation  of 
this  malady.  Several  observers  have  con- 
firmed the  existence  of  a  faulty  splitting 


318  MEDICAL  ASPECTS  OF  CANCER 

of  nitrogenous  elements  and  an  increase 
of  amino-acid  nitrogen  in  those  afflicted 
with  cancer. 

In  view  of  all  this,  once  more,  what 
should  the  medical  practitioner  do  with 
regard  to  cancer?  Of  course,  it  is  readily 
seen  that  the  mere  excision  of  the  particu- 
lar local  lesion  which  has  developed  some- 
where never  can  eradicate  the  systemic 
error  that  produced  it  and  which  probably 
will  cause  a  recurrence :  nor  can  the  rr-rays 
or  radium-treatments  be  expected  to  effect 
such  a  change. 

All  surgeons  agree  about  50  per  cent,  of 
the  cases  are  inoperable  when  first  seen 
by  them.  Of  the  remaining  50  per  cent, 
few  claim  more  than  25  per  cent,  perma- 
nent cure  of  the  general  run  of  cases,  ex- 
cluding those  of  skin-cancer.  This  makes 
only  12.5  per  cent,  of  the  total  number  of 
cases  of  true  cancer,  or  about  90  per  cent. 
of  deaths,  when  we  consider  the  number  of 
cases  lost  sight  of  or  with  late  recurrences. 

It  would  be  quite  impossible  here  to  in- 


CANCER  IN  GENERAL  PRACTICE  319 

dicate  the  exact  lines  of  treatment,  die- 
tetic, medicinal,  local,  and  so  on,  that  the 
medical  practitioner  should  pursue,  and 
which  have  been  more  or  less  detailed 
elsewhere. 

As  the  surgeons  have  been  so  strenuous 
of  late  in  insisting  on  the  early  recogni- 
tion and  treatment  of  cancerous  lesions, 
so  as  to  medical  treatment  the  best  results 
can,  undoubtedly,  be  secured  by  the  earli- 
est possible  detection  of  the  disease.  As 
patients  recognize  that  they  can  escape  the 
knife  and  that  there  is  a  far  greater  ex- 
pectation of  cure  by  means  of  proper  and 
prolonged  medical  treatment,  they  will  be 
less  inclined  to  hide  the  trouble  until  too 
late,  and  it  can  be  more  easily  overcome 
by  proper  medical  care. 

People,  therefore,  should  be  encouraged 
to  report  any  questionable  signs  of  the 
disease  at  the  earliest  possible  moment, 
and  the  case  should  be  minutely  investi- 
gated and  active  treatment  begun  at  once, 
and  continued  even  long  after  all  tangi- 


320  MEDICAL  ASPECTS  OF  CANCER 

ble  signs  have  disappeared  for  some  time. 
For,  the  dietary  and  other  proper  meas- 
ures looking  toward  the  correction  of 
the  faulty  metabolism  leading  to  the  dis- 
ease are  harmless  and  often  beneficial  to 
those  who  may  not  have  cancer.  In  ad- 
vanced and  even  inoperable  cases,  very 
active  treatment  may  often  be  of  the 
greatest  service,  as  I  have  elsewhere 
shown. 


CHAPTER  XVII 

CONCLUSIONS  AND  RESULTS  ' 

If  the  statistics  quoted  in  the  preceding 
pages  are  correct,  and  they  can  be  readily 
proved,  if  the  statements  in  regard  to 
laboratory  researches  are  authentic,  and 
they  can  be  verified  by  literature,  and  if 
the  affirmations  of  the  writer,  in  this  and 
the  preceding  volumes,  as  to  results  ob- 
tained by  medical  treatment  are  credible 
and  believed,  serious  attention  should  be 
paid  to  *Hhe  real  cancer  problem'^  as 
presented  in  the  Second  Volume.  In  re- 
gard to  no  other  disease  has  the  profes- 
sion and  the  laity  been  so  blind  as  it  has 
been  in  regard  to  cancer.  But  from  jour- 
nalistic literature  and  personal  communi- 
cations it  would  seem  that  the  medical 
portion  of  the  profession  is  beginning  to 

^  Read  before  the  North  Western  Medical  and  Surgi- 
cal Society,  New  York  City,  February  19th,  1919. 

321 


322  MEDICAL  ASPECTS  OF  CANCER 

see  matters  in  their  right  light,  and  the 
day  dawns  brighter  for  the  elimination  of 
the  fearful  morbidity  and  mortality  of 
cancer. 

What  are  we  to  conclude  from  our 
studies  on  cancer,  as  represented  in  the 
preceding  pages?  Is  the  cancer  problem 
solved  completely?  By  no  means;  it  has 
only  begun  to  be  solved,  but  there  are  here 
indicated  the  lines  along  which  the  best 
prospects  are  offered.  For  it  is  evident 
that  surgery  alone  has  had  its  day  and  has 
failed.  Much  more  observation  and  study 
are  needed,  both  in  the  laboratory  and  on 
patients,  but  along  lines  quite  different 
from  those  heretofore  followed.  The  mi- 
croscope has  revealed  about  all  that  is 
possible  in  regard  to  the  histological  char- 
acters of  the  diseased  tissue  and  the  mor- 
phological elements  of  the  blood.  It  is 
refreshing  to  observe  in  the  report  of  the 
Research  Laboratory  of  the  Memorial 
Hospital,  signed  by  Dr.  Ewing,  that  '*The 
extension  of  research  to  clinical  questions 


CONCLUSIONS  AND  RESULTS  323 

made  possible  by  the  increased  endow- 
ment has  not  restricted  the  laboratory- 
studies,  but  on  the  contrary  has  greatly 
added  to  their  number  and  importance. 
The  main  topic  being  investigated  in- 
clude the  influence  of  diets  upon  cancer 
in  lower  animals,  the  chemical  changes  in 
the  blood  and  in  tumor  tissue,  etc/'  It 
would  be  well  if  it  had  been  added  ^^also 
in  patients  in  the  earlier  and  later  stages 
of  cancer, '^ — but  this  will  undoubtedly 
foUow  and  unquestionably  will  be  rich  in 
results. 

What  are  we  to  think  of  the  facts  and 
figures  presented  in  the  preceding  pages? 
Can  they  be  ignored?  For  they  have 
never  been  refuted  in  print  or  in  open  dis- 
cussion, although  abundant  opportunity 
has  been  offered  in  many  medical  societies 
and  the  challenge  is  still  open.  With  the 
marvellous  diminution  in  the  death  rate 
from  tuberculosis  under  rational  treat- 
ment, can  we  refuse  to  apply  the  same, 
properly  devised,  to  cancer,  whose  mortal- 


324  MEDICAL  ASPECTS  OF  CANCER 

ity  has  risen  so  alarmingly  under  the 
treatment  thus  far  given  to  it?  Can  it 
be  anything  but  a  willful  ignorance  to 
ignore  this  line  of  effort? 

In  the  preceding  pages  the  medical  as- 
pect of  cancer  has  been  presented  in  al- 
most every  possible  light,  repeating  neces- 
sarily much  that  has  appeared  in  the  two 
previous  volumes.  Its  connection  with 
diet  has  been  developed  statistically,  ex- 
perimentally, and  clinically.  The  meta- 
bolic changes  constantly  observed  in  pa- 
tients with  early  and  late  cancer  have  been 
recorded,  as  also  the  definite  changes  in 
the  blood.  What  is  lacking  to  carry  a 
conviction  which  shall  result  in  a  general 
change  of  view,  as  to  its  systemic  or 
constitutional  character,  in  place  of  a 
purely  local  nature  of  the  disease?  Con- 
stant new  development  of  cancerous  le- 
sions after  surgical  removal,  metastases, 
or  development  of  the  disease  in  internal 
organs,  and  the  later  phenomena  ending 
in  death,   all   surely   point   to   something 


CONCLUSIONS  AND  EESULTS  325 

more  than  a  local  disease.  Malignant 
primary  disease  in  deep  organs,  the  brain, 
pancreas,  kidney,  liver,  certainly  cannot 
be  accounted  for  by  local  injury. 

The  thesis  or  theory  of  a  systemic  or 
constitutional  origin  of  malignant  as  well 
as  non-malignant  growths  is  fully  sus- 
tained by  all  that  is  summed  up  in  the  one 
word  '^nutrition.''  We  know  that  wrong 
nutrition  accounts  for  tuberculosis,  rickets, 
obesity,  and  many  complaints,  and  we 
know  that  nutrition  depends  upon  the  food 
and  drink  taken ;  and  we  know  that  proper 
nutrition  accounts  for  the  marvellous  re- 
sults obtained  in  tuberculosis,  in  spite  of 
the  continued  presence  of  tubercular  ba- 
cilli. We  know,  further,  that  good  or  bad 
nutrition  depends  also  upon  the  proper  or 
improper  action  of  one  or  more  of  the 
various  internal  organs,  and  is  also  in- 
fluenced by  nervous  conditions.  What 
reasonable  objection  can  be  raised  to  the 
assumption  that  cancer  is  also  due  to  er- 
rors of  nutrition?    K  the  latter  is  true  it 


326  MEDICAL  ASPECTS  OF  CANCER 

follows  naturally  that  the  exactly  proper 
food  and  drink,  together  with  correct  ac- 
tion of  all  the  internal  organs,  will  pre- 
vent and  cure  cancer. 

In  the  first  volume  it  was  remarked  that 
**the  test  of  everything  lies  in  the  results 
obtained.  Theories,  discussions  and  argu- 
ments are  all  unavailing  unless  results 
show  their  truth. '^  This  phrase  was  re- 
peated with  more  force  in  the  second  vol- 
ume. It  is  now  four  years  since  those 
words  were  first  written,  and  they  can 
now  be  repeated  again  with  still  greater 
confidence.  For  these  and  former  years 
of  further  observation  and  treatment  of 
patients  with  cancer  have  abundantly 
demonstrated  the  correctness  of  the 
thoughts  presented,  while  the  study  of  lit- 
erature has  served  only  to  confirm  the 
views  which  have  been  held,  and  on  which 
practice  has  been  based  for  thirty  and 
more  years. 

In  some  few  reviews  of  the  previous 


CONCLUSIONS  AND  RESULTS  327 

agnosis  of  the  cases  reported  was  founded 
on  clinical  grounds  only  and  was  not  es- 
tablished by  the  microscope.  In  answer 
to  this  it  may  be  said  that  in  virtually 
all  the  cases  recorded  then  or  now  the 
diagnosis  had  been  made  previously  or 
confirmed  by  one  or  more  surgeons,  who 
had  urged,  and  in  some  instances  ar- 
ranged for,  immediate  operation.  Also  it 
is  well  known  that  biopsy  before  operation 
is  universally  condemned,  and  it  would 
be  particularly  dangerous  in  patients  who 
underwent  only  medical  treatment.  Fur- 
ther, it  is  to  be  remembered  that  of  the 
vast  number  of  cases  operated  on  the  di- 
agnosis before  operation  is  almost  invari- 
ably clinical. 

Reference  and  further  report  may  be 
made  concerning  some  of  the  cases  re- 
ported in  previous  volumes,  as  illustrat- 
ing and  impressing  what  can  be  done  for 
cancer  by  non-surgical  measures. 

In  the  first  volume  eight  cases  of  can- 
cer  of   the   breast   were   reported,   from 


328  MEDICAL  ASPECTS  OF  CANCER 

among  many  others,  two  of  whom  were 
followed,  remaining  perfectly  well,  sixteen 
years  after  first  beginning  treatment.  The 
second  two  cases  had  been  watched  and 
continued  perfectly  well  for  nine  years 
under  medical  treatment  alone:  that  was 
four  years  ago,  and,  traced  recently,  they 
remain  still  well,  thirteen  years  after 
being  first  seen.  The  next  three  cases 
were  of  inoperative  recurrent  cancer,  one 
of  whom  showed  most  remarkable  gain 
during  her  stay  of  four  months  and  a  half 
in  the  New  York  Skin  and  Cancer  Hos- 
pital, the  details  of  which  were  fully  re- 
ported. One  of  the  cases,  in  private  prac- 
tice, was  watched  almost  sixteen  months, 
and  when  lost  sight  of,  that  she  might 
take  a;-rays  nearer  her  home  in  the  coun- 
try, a  very  large  share  of  the  cutaneous 
nodules  had  disappeared,  and  she  had 
lived  comfortably  and  without  pain,  and 
the  disease  which  would  have  carried  her 
off  long  before  had  certainly  in  a  measure 
been    checked.     The    last    case    was    de- 


CONCLUSIONS  AND  RESULTS  329 

scribed  as  showing  how  much  could  be 
done  even  in  a  most  hopeless  condition. 
The  lady  for  two  years  had  neglected  a 
diseased  breast,  until  it  was  the  size  of 
half  a  melon,  hard  and  immovable,  with 
some  superficial  ulceration  and  with  enor- 
mous axillary  and  supra-clavicular  glands 
and  profound  cachexia:  the  trouble  had 
been  revealed  to  no  one  until  the  day  be- 
fore her  visit,  when  a  physician  and  sui- 
geon  pronounced  it  hopeless.  For  seven 
months  under  careful  treatment  she  lived 
comfortably,  the  breast  softening  very 
greatly,  and  diminishing  to  about  the  size 
of  the  other,  and  the  glandu^ir  swellings 
becoming  about  one-half  the  size.  She 
passed  peacefully  away  with  exhaustion 
and  pulmonary  oedema,  about  seven 
months  after  being  first  seen  without  hav- 
ing taken  a  particle  of  morphia  or  other 
hypnotic.  In  all  my  cases,  even  in  recur- 
rent cancer,  it  has  so  rarely  been  neces- 
sary to  use  these  that  I  can  recall  hardly 
any  instance  where  they  were  employed: 


330  MEDICAL  ASPECTS  OF  CANCER 

when  under  full  dietetic  and  medicinal 
treatment  the  element  of  pain  is  almost 
negligible.  Opiates  check  the  secretions 
and  excretions,  and  retard  metabolism, 
and  in  my  experience  increase  the  ten- 
dency to  an  extension  of  the  carcinosis. 

In  the  second  volume  nine  more  cases 
of  malignant  neoplasm  were  reported,  in 
which  the  results  of  this  line  of  treatment 
were  shown.  One  was  a  very  remarkable 
case  of  sarcoma  of  the  upper  jaw,  recur- 
rent after  operation.  The  final  result  of 
this  was  a  plastic  operation  to  cover  the 
large  ulcerative  opening  which  had  com- 
pletely healed  in  about  four  months,  dur- 
ing which  time  she  had  gained  from  89% 
to  130  pounds,  which  latter  was  10  pounds 
more  than  she  had  ever  weighed  before. 
The  thick  skin  graft  to  cover  the  opening 
took  at  once  perfectly,  and  she  remains 
well  two  years  since  I  reported  the  case. 

Six  cases  of  cancer  of  the  breast  were 
recorded,  three  primary  and  non-op- 
erative, and  two  of  recurrent  cancer,  one 


CONCLUSIONS  AND  RESULTS  331 

of  whom  had  been  submitted  to  four  op- 
erations, and  the  last  one  with  an  im- 
mense ulcerative  mass  of  the  right  side 
of  the  chest,  which  was  transferred  to 
my  medical  service  in  the  hospital  by  the 
surgeons,  as  being  absolutely  inoperable. 
This  last  patient  made  a  splendid  fight, 
for  about  a  year,  gaining  in  flesh,  with 
a  blood  count  raised  to  4,110,000,  and 
sleeping  well  without  the  opiate  she  had 
previously  taken.  The  case  was  a  very 
difficult  one,  as  the  kidneys  refused  to 
excrete  anywhere  near  the  proper  amount 
of  solids  required,  and  she  passed  away 
easily  a  year  after  entering  my  service. 

Of  the  other  two  cases  of  post-operative 
cancer  of  the  breast,  I  may  report  that  the 
one  who  had  had  four  operations  (case 
IV)  did  remarkably  well  for  a  while,  al- 
though when  first  seen  there  was  a  large 
ulcerating  surface  over  the  site  of  former 
operations,  on  the  left  side,  with  axillary 
glands  enlarged,  and  a  greatly  swollen 
left  arm.    Five  months  later  she  wrote 


332  MEDICAL  ASPECTS  OF  CANCER 

that  she  felt  very  well  and  '*  friends  think 
that  there  cannot  be  very  much  the  mat- 
ter with  me.^'  She  made  occasional  trips 
from  a  distant  town  until  about  eight 
months  from  the  first  visit  when  she  fell 
and  broke  her  hip;  treatment  was  then 
interfered  with  for  some  time  and  she 
began  to  go  down  and  passed  away  about 
a  year  after  I  first  saw  her.  The  other 
recurrent  case  where  both  breasts  had 
been  removed  two  years  previously,  had 
a  great  development  of  cutaneous  nodules 
on  both  sides  of  the  chest,  forming  a  veri- 
table *^  cancer  en  cuirasse.''  She  was 
treated  in  the  out-patient  medical  clinic 
of  the  hospital,  and  when  I  presented  her 
at  my  lecture  clinic  about  four  months 
later  her  condition  was  so  changed  that 
there  was  hardly  a  trace  of  the  nodules 
on  passing  the  hand  over  the  surface. 
She  had  been  working  hard  all  the  time 
and  had  had  no  pain  since  soon  after  be- 
ginning the  treatment.  She  disappeared 
soon  after  that  and  I  could  not  trace  her. 


CONCLUSIONS  AND  EESULTS  333 

Of  the  three  primary  cases,  non-opera- 
tive, in  private  practice,  two  seem  to  have 
recovered,  and  the  other  (Case  I)  made 
a  most  wonderful  fight  under  very  adverse 
circumstances,  working  very  hard  and 
with  much  family  sickness  and  death.  She 
had  a  hard  mass  in  the  left  breast,  at- 
tached to  the  skin  and  with  enlarged  ax- 
illary glands,  and  had  been  given  six 
months  to  live  by  a  surgeon  of  prom- 
inence, if  not  operated  on.  The  improve- 
ment in  her  general  condition  and  the 
mass  in  the  breast  seemed  so  good,  after 
the  first  few  months  that  it  appeared  as  if 
the  disease  would  yield  entirely:  she  had 
been  to  Chicago  and  back  by  auto,  slept 
perfectly,  had  no  pain  and  felt  perfectly 
well.  Ten  months  after  her  first  visit  she 
had  a  very  severe  attack  of  grip,  being 
in  bed  three  weeks  in  another  city,  and 
this,  with  many  weeks  neglect  of  treat- 
ment, set  her  back,  and  she  was  lost  sight 
of  about  fourteen  months  after  she  had 
been  given  six  months  to  live. 


334  MEDICAL  ASPECTS  OF  CANCEE 

The  other  two  cases  were  most  satisfac- 
tory. One  of  them,  whose  breast  tumor 
was  diagnosed  as  cancer  by  at  least  four 
medical  men,  one  of  them  a  prominent 
surgeon,  remained  absolutely  free  from 
trouble  when  examined  five  and  a  half 
years  after  her  first  call.  The  other  pa- 
tient (ease  II)  was  then  reported  as  per- 
fectly well  and  free  from  any  breast  trou- 
ble two  years  after  being  first  seen;  she 
had  been  confined  of  a  healthy  child  two 
years  ago,  and  was  examined  on  Sept. 
23rd,  1918,  more  than  four  years  after 
her  first  visit;  there  was  no  trace  of  the 
breast  tumor  and  she  was  in  excellent 
health. 

Two  cases  of  totally  inoperable  cancer 
of  the  uterus,  as  diagnosed  by  several  sur- 
geons, were  there  reported;  both  had  re- 
covered, as  evidenced  by  the  careful  ex- 
aminations of  several  physicians  and  sur- 
geons. One  of  them  (case  VII)  has  been 
under  my  constant  observation  and  treat- 
ment during  these  two  years,  travelling 


CONCLUSIONS  AND  RESULTS  335 

many  times  from  a  far-distant  city,  and  is 
in  as  perfect  health  as  conld  be  desired, 
still  weighing  more  than  she  did  at  first, 
walking  much,  and  a  recent  examination 
reports  that  both  of  these  cases  are  *'free 
from  any  evidence  of  disease/' 

In  the  second  volume  was  given  a  list 
of  the  cases  of  malignant  disease,  upon 
which  the  studies  were  based,  and  it  is 
not  necessary  to  refer  to  these  again,  nor 
to  detail  others  of  the  cases  similar  to 
those  already  reported.  Reference  will 
therefore  be  made  to  those  seen  in  the 
two  years  since  its  publication,  and  only 
those  in  private  practice  will  be  counted, 
as  hospital  cases  are  not  nearly  as  satis- 
factory as  those  among  the  more  educated 
classes  in  private  practice. 

A  considerable  number  of  these  patients 
were  only  seen  in  consultation,  or  a  sin- 
gle time,  and  a  number  of  them  have 
been  treated  only  for  a  short  period,  too 
short  to  report  definitely  concerning  them. 
But  there  were  21  who  were  treated  suf- 


336  MEDICAL  ASPECTS  OF  CANCER 

ficiently  long  to  observe  distinct  im- 
provement, as  recorded  on  their  histories. 
When  we  realize  the  ordinary  course  of 
cancer,  and  that  when  not  improving  pa- 
tients constantly  get  worse,  we  cannot  ig- 
nore a  steady  gain.  And  in  the  light  of 
the  cases  previously  mentioned,  we  must 
realize  that  when  one  improves  and  goes 
up  hill  in  regard  to  the  disease  and  in 
general  health  continuously,  one  is  not 
likely  to  go  down  hill  at  the  same  time; 
and,  moreover,  if  the  same  conditions  and 
treatment  are  faithfully  persisted  in  long 
enough,  there  is  reason  to  expect  that  the 
final  result  will  be  favorable,  as  it  has 
been  in  so  many  instances  during  the 
many  years  past. 

During  the  last  two  years,  since  the 
second  volume  was  published  I  find  case 
histories,  more  or  less  complete  of  140 
new  cases  of  malignant  disease  affecting 
different  locations.  Of  these  43  cases 
were  of  cutaneous  epithelioma,  which  lat- 
ter are  excluded  from  our  present  study, 


CONCLUSIONS  AND  RESULTS  337 

as  are  also  a  number  of  cases  of  suspected 
cancer  and  non-malignant  tumors.  Of  the 
remaining  65  cases  there  were  39  patients 
with  cancer  of  the  breast,  3  of  the  uterus, 
5  of  the  stomach,  2  of  the  rectum,  1  of 
the  bladder,  1  of  the  kidney,  2  of  the 
prostate,  5  of  the  buccal  cavity,  32  of  the 
lip,  1  of  the  axilla,  and  6  of  sarcoma,  three 
of  which  were  in  the  buccal  cavity. 

These  cases  were  seen  in  all  stages  of 
the  disease,  27  were  recurrent  after  from 
one  to  three  operations,  and  38  were  pri- 
mary cases.  With  hardly  an  exception,  I 
believe  all  the  latter  had  been  seen  by 
other  medical  men,  who  had  made  the 
clinical  diagnosis  of  cancer,  and  many  had 
been  strenuously  urged  by  surgeons  of  re- 
pute to  have  an  immediate  operation,  as 
the  only  hope  of  saving  life.  I  have  else- 
where mentioned  the  universal  belief 
among  the  best  men  that  to  attempt  to 
take  a  section  for  microscopic  examination 
is  extremely  dangerous  in  surgical  cases, 
and   it   would   be   almost   fatal   in   those 


338  MEDICAL  ASPECTS  OF  CANCER 

treated  medically.  Many  of  the  recurrent 
cases  have  experienced  the  greatest  ben- 
efit from  the  line  of  treatment  advocated 
in  these  volumes,  as  indicated  in  some  of 
those  previously  reported,  and  in  those  to 
be  given.  In  some  instances  life  has  been 
prolonged  far  beyond  that  expected  and 
prognosticated  by  the  surgeon,  and  with 
a  measure  of  comfort  often  most  gratify- 
ing. As  far  as  I  have  learned  there  have 
been  six  deaths,  but  there  were  probably 
many  more,  as  a  number  of  those  seen  in 
consultation  were  far  advanced.  Brief 
mention  may  be  made  of  some  interesting 
points  in  connection  with  certain  pri- 
mary and  secondary  cases. 

Cancer  of  the  hreast.  The  average  age 
of  these  39  patients  was  just  47,  the 
youngest  27  and  the  oldest  85:  twenty  of 
them  were  between  40  and  50  years  of 
age  when  seen.  There  were  22  married 
and  17  single.  In  24  cases  the  left  breast 
was  affected,  in  10  the  right  breast,  both 
breasts  in  3  cases,  and  unrecorded  in  one 


CONCLUSIONS  AND  EESULTS  339 

case.  The  duration  of  the  disease  before 
observation  varied  from  a  week  or  two  in 
one  instance  to  six  years  in  one  lady  aged 
59,  who  had  never  been  operated  on;  the 
average  was  about  a  year  and  a  half,  but 
there  were  a  number  of  the  primary  cases 
who  came  quite  early,  and  in  them  nat- 
urally there  were  the  best  results.  Of 
these  breast  cases  19  were  recurrent  after 
from  one  to  three  operations,  or  a;-ray  or 
radium,  and  20  were  primary,  who  had 
never  been  operated  on.  I  must  first 
mention  one  additional,  very  interesting 
case  treated  in  the  medical  clinic  for  can- 
cer at  the  hospital. 

Case  I:  Mrs.  S.  J.,  aged  33,  first  no- 
ticed a  lump  in  the  right  breast  two 
months  previous  to  her  visit,  Feb.  28th, 
1917.  This  steadily  increased  until  seen, 
when  it  was  fully  an  inch  and  a  half  in 
either  direction,  in  about  the  median  line 
above  the  nipple,  with  sharp  rather  hard 
edges,  and  a  small,  palpable  gland  in  the 
axilla:  she  had  been  having  sharp  pains 


340  MEDICAL  ASPECTS  OF  CANCER 

radiating  from  the  breast  to  the  axilla. 
To  confirm  the  diagnosis  I  called  in  the 
surgeon  in  attendance  who  at  once  recog- 
nized it  as  carcinoma  and  strongly  urged 
an  immediate  removal,  as  the  only  hope, 
my  assistants  also  agreeing  as  to  the  di- 
agnosis. She  was  extremely  constipated, 
the  mouth  dry  and  the  saliva  acid.  She 
was  placed  on  the  usual  dietary  and  me- 
dicinal treatment  and  in  two  weeks  it  was 
recorded  that  she  felt  better  than  for  a 
year.  The  lump  was  materially  smaller, 
though  the  edges  were  sharp  and  nodular. 
There  was  no  pain  except  in  extreme  ex- 
ertion, doing  her  housework  and  caring 
for  two  children.  She  was  faithful  to 
treatment,  generally  coming  every  week, 
and  six  months  later  it  was  recorded  that 
the  lump  had  markedly  diminished,  being 
about  an  inch  in  diameter,  and  very  shal- 
low, and  with  absolutely  no  pain.  Six 
months  still  later  practically  nothing 
could  be  felt.  About  a  year  or  more  after 
her  first  visit  three  physicians  were  told 


CONCLUSIONS  AND  EESULTS  341 

that  she  had  had  a  breast  tumor,  and  all 
of  them  feeling  the  breasts  decided  that 
it  must  have  been  in  the  left  breast,  in- 
stead of  the  right,  as  there  was  a  slight 
chronic  mastitis  there.  Very  recently  a 
fourth  physician  made  the  same  mistake. 
She  had  been  pregnant  and  gave  birth  to 
a  dead  bom  child.  When  seen  recently, 
nearly  two  years  after  the  j&rst  call,  there 
was  nothing  to  be  felt  in  the  right  breast, 
but  still  a  little  chronic  mastitis  in  the 
left. 

One  of  my  assistants  recently  reported 
to  me  a  very  similar  case,  where  the  lump 
had  disappeared,  and  after  a  year  the 
same  mistake  was  made  by  a  doctor  ex- 
amining both  breasts,  who  decided  wrong- 
ly as  to  which  had  been  affected. 

Case  II:  Miss  C.  M.  S.,  aged  35,  seen 
first  January  15th,  1917.  Six  months  be- 
fore she  had  a  severe  blow  on  the  right 
breast  which  soon  enlarged  and  was  pain- 
ful, it  had  been  poulticed  and  iodex  ap- 
plied.   When  first  seen  there  was  a  lump, 


342  MEDICAL  ASPECTS  OF  CANCER 

the  size  of  an  English  walnut,  quite  well 
defined,  and  with  darting  pain;  no  axil- 
lary glands  were  felt,  though  small  en- 
largements developed  two  months  later, 
as  she  had  neglected  the  treatment  given. 
After  a  few  weeks  of  rigid  treatment  the 
breast  was  softer,  with  some  pain  and 
drawn  feeling.  Two  months  later  the 
right  breast  felt  almost  the  same  as  the 
left,  though  there  was  still  a  sharp  mar- 
gin in  one  place.  When  last  seen,  about 
18  months  after  the  first,  the  right  breast 
was  normal,  but  a  little  caking  in  the 
left  breast,  and  she  had  had  some  little 
feeling  in  both  breasts  during  menstrua- 
tion. This  was  a  difficult  case  to  handle, 
as  she  had  much  care,  work,  and  trouble 
keeping  a  boarding  house,  with  her  mother 
sick  at  times.  She  had  much  gastric  dis- 
turbance and  was  much  constipated  before 
treatment. 

Case  ni:  Miss  G.  D.,  aged  45,  was 
under  treatment  for  eczema  which  had 
about    disappeared,    when     on    January 


CONCLUSIONS  AND  RESULTS  343 

22nd,  1917,  she  called  attention  to  a  lump 
in  the  left  breast  which  had  existed  for 
six  months  or  more.  It  was  just  above 
the  nipple,  the  size  of  an  egg^  with  sharp 
edges  and  some  adherence  to  the  skin,  with 
some  glandular  enlargement  and  sharp 
pain  occasionally.  This  patient  has  been 
under  frequent  observation  and  constant 
treatment  now  for  almost  two  years,  and 
while  the  lump  has  not  wholly  disap- 
peared it  is  not  one-half  the  size,  is  softer 
and  without  the  sharp  edges,  and  the 
glands  can  hardly  be  felt:  there  is  rarely 
any  pain,  except  after  much  exertion. 
She  keeps  her  color  and  weight  well,  and 
has  been  active  as  an  attendant  upon  an 
elderly  lady.  There  is  every  reason  to 
believe  that  the  absorbing  process  will  go 
on,  as  she  is  very  faithful  to  treatment, 
and  that  ultimately  the  trouble  will  dis- 
appear entirely. 

Case  IV:  Mrs.  G.  K.  L.,  aged  59,  re- 
ceived a  slight  blow  on  the  inner  upper 
quadrant  of  the  left  breast,  and  immedi- 


344  MEDICAL  ASPECTS  OF  CANCER 

ately  felt  a  peculiar  sensation  which 
passed  off,  and  the  lump  was  not  noticed 
until  four  years  ago.  Since  then  the 
breast  has  felt  heavy  and  gradually  the 
mass  increased  in  size,  until  it  was  about 
3%  inches  in  diameter,  hard  and  charac- 
teristic, when  first  seen,  with  some  en- 
larged glands  in  the  axilla.  She  had  been 
under  a  partial  ^^ Green  card"  diet  for  a 
year.  Being  placed  on  very  strict  diet 
with  medication,  at  the  end  of  three 
months  the  tumor  had  diminished  more 
than  one-half  in  size,  and  was  much  soft- 
er, as  verified  by  another  physician.  She 
had  gained  4  pounds  from  the  first,  in 
good  color,  and  felt  better  than  she  had 
for  a  long  time. 

Case  V:  Miss  L.  M.,  aged  55,  a  recent 
case,  presents  points  of  interest.  Four- 
teen months  before  her  visit,  November 
4th,  1918,  she  noticed  a  small  lump  in  the 
right  breast,  which  had  been  kept  secret 
until  a  week  previously.  It  was  painful 
from  the  first,  the  pain  increasing  as  the 


CONCLUSIONS  AND  EESULTS  345 

mass  grew,  until  of  late  it  had  caused 
many  sleepless  nights.  When  first  seen 
there  was  a  large  mass,  two  or  three  inches 
in  diameter  in  the  inner  upper  segment, 
near  the  nipple,  with  a  purplish  red,  pro- 
truding area  an  inch  in  diameter.  The 
whole  breast  was  tense,  and  the  axillary 
glands  enlarged  and  painful  on  handling: 
there  was  no  supraclavicular  adenopathy. 
The  almost  immediate  relief  to  many 
symptoms  from  a  strict  vegetarian  diet, 
according  to  the  ''green  card"  previously 
referred  to,  and  appropriate  medical  treat- 
ment, was  surprising.  In  a  week  the  tense- 
ness of  the  breast  had  materially  lessened, 
and  the  pain  was  decidedly  less.  After  ten 
days  the  lump  was  less  hard  and  the  axil- 
lary glands  less  prominent.  A  week  later 
the  purplish  color  had  almost  gone,  ichtarol 
having  been  applied  frequently  from  the 
first,  and  the  axillary  glands  had  dimin- 
ished one-third  or  more,  as  verified  by  a 
physician  who  watched  the  case  with  me. 
While  the  final  result  with  such  a  large 


346  MEDICAL  ASPECTS  OF  CANCER 

tmnor  cannot  be  surely  foretold,  if  im- 
provement should  be  arrested  I  might 
have  the  offending  mass  removed  by  the 
Strobel  chemical  extirpation,  as  was  done 
in  the  case  next  to  be  mentioned.  This 
avoids  severing  blood  vessels  and  lym- 
phatics, which  are  sealed  by  the  caustics, 
and  the  process  is  not  commonly  followed 
by  the  recurrence  so  common  after  re- 
moval by  the  knife. 

Case  VI:  Mrs.  L.  H.,  aged  36,  came 
under  observation  and  treatment  Septem- 
ber 20th,  1918.  She  had  had  two  chil- 
dren, one  12  years  of  age,  who  had  been 
nursed  three  months,  and  one  six  years 
old.  She  had  much  milk  in  the  left  breast 
but  the  nipple  was  sore  for  two  weeks  and 
the  baby  was  weaned.  Her  mother  had 
died  of  malignant  disease  of  the  bladder, 
at  the  age  of  55.  Fourteen  months  pre- 
vious to  her  visit  she  had  first  noticed  a 
lump  in  the  left  breast,  the  size  of  a  mar- 
ble, which  had  increased  gradually,  but 
was    supposed    to    be    doing    well    under 


CONCLUSIONS  AND  EESULTS  347 

vegetable  diet  and  various  medications, 
until  she  had  a  severe  blow  on  that  breast 
two  months  before  coming  for  treatment; 
since  that  time  it  had  increased  rather 
rapidly,  with  shooting  pains  extending 
down  the  left  arm.  When  first  seen  there 
was  a  large,  hard  mass  in  the  upper  outer 
segment  of  the  left  breast,  2  or  3  inches 
in  diameter,  adherent  to  the  skin,  with  a 
moderately  reddened  area,  an  inch  or  so 
in  diameter.  The  saliva  was  acid  and 
the  urinary  excretion  insufficient  in  its 
solid  ingredients.  Under  active  dietary 
and  other  treatment  it  was  recorded  one 
month  later  that  the  breast  was  less  swol- 
len and  less  red,  but  that  she  still  had 
considerable  pain  the  previous  week,  dur- 
ing the  menstrual  period,  and  that  the 
axillary  adenopathy  seemed  more  pro- 
nounced, and  one  or  two  enlarged  supra- 
clavicular glands  were  found  a  week  later. 
She  had  however  done  well  physically, 
had  gained  in  flesh  a  little,  had  good 
color,   slept  well  without  pain,   but  had 


348  MEDICAL  ASPECTS  OF  CANCER 

some  darting  pains  during  the  day  time. 
In  view  of  the  size  of  the  tumor  and 
her  general  nervous  condition,  and  the  ex- 
treme tediousness  of  its  medical  removal 
I  decided  that  it  would  be  wiser  to  have 
the  breast  removed  by  local  caustic  treat- 
ment, as  I  have  had  a  number  of  my  cases 
so  treated  at  the  New  York  Skin  and 
Cancer  Hospital  hj  Dr.  Strobel,  with  good 
results.  The  process  was  begun  on  Oct. 
31st,  the  last  application  of  the  plaster 
being  made  on  November  9th.  On  ac- 
count of  the  difficulty  in  reaching  and  re- 
moving the  enlarged  axillary  glands,  skin 
grafting  was  not  done  until  November 
26th,  when  there  was  still  some  slough- 
ing to  take  place  in  the  axilla.  The 
grafts  took  perfectly  over  the  breast  area, 
giving  a  smooth,  healthy  surface,  leaving 
still  some  raw  space  in  the  axilla,  to  be 
treated  later.  The  slough  there  finally 
separated  on  December  8th  and  skin  graft- 
ing was  done  December  13th,  and  has 
taken  well. 


CONCLUSIONS  AND  RESULTS  349 

One  or  two  cases  may  be  mentioned 
to  illustrate  what  can  be  done  for  pa- 
tients where  the  disease  has  recurred 
after  one  or  more   surgical  removals. 

Case  VII:  Miss  H.  K,  aged  45,  first 
seen  December  17th,  1917,  had  noticed  a 
lump  in  the  right  breast  in  April,  1915; 
this  had  been  removed  surgically  within 
three  months,  with  a  good  axillary  opera- 
tion the  following  July  14th.  About  the 
middle  of  June,  1917,  she  noticed  a  lump 
in  the  left  breast,  in  the  outer,  lower  seg^ 
ment.  When  seen  there  was  a  mass  the 
size  of  an  egg,  hard  and  with  some  ir- 
regular nodosities;  the  glands  along  the 
pectoral  muscle  were  enlarged,  with  some 
doubtful  axillary  adenopathy.  She  was 
always  constipated  and  the  saliva  was 
acid;  the  menopause  had  not  yet  occurred. 
Placed  on  a  strict  diet  and  medication 
she  has  been  very  faithful,  though  living 
in  a  distant  city,  and  coming  to  New  York 
many  times  up  to  the  present.  The  tumor 
is  materially  smaller  and  softer,  and  no 


350  MEDICAL  ASPECTS  OF  CANCER 

adenopathy  can  be  detected.  When  we 
consider  what  would  ordinarily  happen  in 
such  a  case  in  a  year,  and  contrast  her 
present  condition,  when  she  says  that  she 
**feels  very  well  indeed",  there  is  certain- 
ly reason  to  believe  in  the  internal  rela- 
tions of  cancer. 

Case  VIII:  Mrs.  B.  E.,  aged  49,  had 
the  right  breast  removed,  by  a  very  com- 
plete axillary  operation  for  adeno-carcino- 
ma,  by  one  of  the  leading  snrgeons  in 
New  York,  on  September  27th,  1916.  She 
had  never  thought  of  the  breast  until  five 
or  six  weeks  before  the  operation,  the  lump 
beginning  the  size  of  a  walnut  and  growing 
rapidly  in  extent,  with  glandular  enlarge- 
ment. Four  months  after  the  operation, 
January  30th,  1917,  she  came  under  ob- 
servation and  treatment  with  recurrence 
in  the  axilla,  a  swollen  arm,  paining  and 
aching,  and  some  areas  of  tenderness. 
She  had  long  had  persistent  constipation, 
depending  on  cathartics  all  the  time. 
She  had  borne  three  children,  21,  20,  and 


CONCLUSIONS  AND  RESULTS  351 

13  years  of  age;  the  menses  had  ceased 
five  years.  For  almost  two  years  she 
has  been  a  most  faithful  patient,  coming 
almost  weekly  from  a  neighboring  town, 
except  during  the  summers  when  she  was 
far  away,  and  wrote  occasionally.  The 
course  of  this  case  has  been  interesting 
6ut  not  wholly  satisfactory,  showing  how 
deeply  seated  is  the  constitutional  error 
which  first  manifests  itself  in  a  single 
/esion  in  the  breast,  and  that  the  early 
and  perfect  removal  of  this  could  not  ar- 
rest its  progress. 

During  these  nearly  two  years  with 
complete  and  careful  carrying  out  of  all 
dietary  and  medicinal  measures,  there 
have  been  repeated  manifestations  of  the 
cancerous  dyscrasia,  in  the  way  of  cuta- 
neous nodules  and  erythematous  patches, 
with  also  axillary  and  supraclavicular 
adenopathy,  and  latterly  bone  involvement 
in  the  sternum  and  cough,  indicating  in- 
ternal adenopathy.  But,  on  the  other 
hand,  without  this  constant  and  faithful 


352  MEDICAL  ASPECTS  OF  CANCER 

treatment  the  disease  would  undoubtedly 
have  had  a  lethal  ending  long  ago.  More- 
over until  quite  recently  she  had  had  no 
pain  to  speak  of  and  has  never  taken 
a  narcotic,  and  has  been  active  and  with 
a  good  color.  For  the  last  few  months 
she  has  had  much  anxiety  in  regard  to 
her  two  sons,  who  are  at  the  front 
in  France,  which  has  had  a  manifest 
effect  on  the  disease.  During  the  treat- 
ment she  has  had  many  applications  of 
the  rr-ray  to  glandular  enlargements,  and 
also  latterly  radium  emanation  insertion  in 
some  of  them,  and  radium  to  the  sternal 
lesion  by  a  most  competent  operator. 
Although  the  total  results  have  not  yet 
been  satisfactory,  there  is  hope  that  with 
the  nervous  strain  removed  by  the  shortly 
expected  return  of  her  sons  from  the  war, 
she  may  respond  better  to  further  treat- 
ment. Latterly,  however,  the  cough  and 
shortness  of  breath  have  increased,  and  on 
November  29th,  72  ounces  of  fluid  were 
drawn  from  the  pleura.     This  exhausted 


CONCLUSIONS  AND  EESULTS  353 

her,  as  learned  by  letter  from  her  hus- 
band, in  a  distant  town,  and  matters  look 
serious.  He  adds  however,  *'I  am  fully 
convinced  that  you  have  added  consider- 
able to  her  life,  in  comfort  and  length  of 
days.*' 

Cancer  of  the  uterus.  Three  cases  of 
cancer  of  the  uterus  were  recorded,  one  of 
which  was  seen  only  once  in  consultation, 
very  far  advanced  and  under  large  doses  of 
morphine  for  months.  The  other  two, 
totally  inoperable,  and  ultimately  fatal 
cases,  exhibited  in  a  striking  manner  the 
great  value  of  proper  medical  treatment. 

Case  IX:  Mrs.  N.  R.  M.,  aged  55,  was 
first  seen  December  27th,  1917.  She  had 
been  examined  by  Dr.  John  Gr.  Clark,  of 
Philadelphia,  and  others,  with  the  diag- 
nosis, of  inoperable  cancer,  with  not  over 
six  months  to  live.  There  was  a  ^' great 
ragged  crater,  extending  back  to  the  rec- 
tum and  forward  almost  into  the  bladder, 
and  laterally  to  the  pelvic  walls.*'  She 
was  then  examined  by  one  of  the  surgeons 


354  MEDICAL  ASPECTS  OF  CANCER 

of  the  New  York  Skin  and  Cancer  Hospi- 
tal, where  she  was  treated,  with  confirma- 
tion of  the  condition,  and  a  very  hopeless 
prognosis  was  given,  of  but  few  months  to 
live.  She  had  two  children,  35  and  30 
years  of  age,  and  the  menses  were  normal 
up  to  their  cessation  three  years  ago.  But 
nine  months  ago  she  had  a  profuse  watery 
vaginal  discharge  and  occasional  bleed- 
ings since,  with  pain  over  the  pubis.  On 
entering  the  hospital  she  had  an  offen- 
sive bloody  discharge.  She  had  been 
habitually  constipated  and  the  saliva  was 
found  to  be  very  acid. 

She  was  treated,  as  were  the  other  uter- 
ine cases  already  reported,  dietetically  and 
medically,  and  with  a  vaginal  douche  of 
very  hot  water,  one  pint,  containing  half  a 
teaspoonful  of  carbolic  acid  and  two  of 
borax,  thrown  in  deeply  and  strongly  with 
a  Davidson's  syringe,  night  and  morning, 
and  later  also  at  noon.  Within  about  a 
month  there  was  a  marked  improvement  in 
her  looks  and  feelings.    The  douche  came 


CONCLUSIONS  AND  EESULTS  355 

away  clear,  with  no  blood  and  only  a  little 
cloudy  with  a  few  shreds,  and  with  no  odor. 
The  urine,  which  had  been  scanty,  in- 
creased to  quite  a  normal  amount  and 
character,  and  the  saliva  became  neutral, 
she  slept  well  most  of  the  time,  without 
much  pain  in  the  pubic  region.  She  was 
given  in  addition  capsules  of  the  pyro- 
phosphate of  iron  and  her  color,  weight 
and  vigor  improved,  so  that,  in  the  light 
of  the  other  cases,  it  seemed  as  though 
she  would  pull  through.  But  the  dullness 
above  the  pubis  slowly  increased,  with 
bowel  obstruction  and  tjonpanites,  the 
urine  became  scanty  and  albuminous,  with 
swollen  legs  and  feet  and  other  signs  of 
serious  kidney  involvement.  The  blood, 
which  had  been  fairly  normal  showed 
great  degeneration,  with  only  50  per  cent, 
haemoglobin,  1,350,000  erythrocytes,  13,000 
leucocytes,  of  these  70  per  cent,  polynu- 
clear,  5  large  mononuclear,  50  small 
mononuclear,  4  transitional  and  1  eosini- 
phile.    She  finally  passed  peacefully  away 


356  MEDICAL  ASPECTS  OF  CANCER 

in  coma  on  August  16th  without  requiring 
or  having  taken  a  particle  of  morphia  or 
other  hypnotic,  except  a  small  dose  of 
chloral  and  bromide  occasionally  at  night 
when  sleepless.  She  had  some  sciatic 
pain  which  was  helped  by  the  free  use  of 
aspirin. 

When  we  consider  the  course  of  the 
disease  in  this  patient,  with  her  constant 
hopefulness  and  comfort  during  these 
eight  months,  instead  of  six  months  or 
less,  as  compared  with  the  agony  often 
suffered,  especially  in  cases  recurrent 
after  operation,  and  the  amount  of  mor- 
phia often  taken,  there  is  reason  for  be- 
lieving in  the  value  of  the  proper  consti- 
tutional treatment  of  cancer.  With  the  enor- 
mous infiltration  of  the  abdominal  viscera, 
and  the  great  ulceration,  the  case  was,  of 
course,  hopeless  from  the  beginning. 

Case  X:  Mrs.  T.  F.  V.,  aged  64,  first 
noticed  bleeding  from  the  vagina  three 
months  before  her  first  visit,  November 
23rd,  1917.     She  had  had  pain  in  the  back 


CONCLUSIONS  AND  EESULTS  357 

a  little  while  before,  and  some  bleeding 
every  two  weeks,  and  for  a  day  or  two  at 
a  time.  She  had  not  felt  well  since  June, 
and  had  lost  twenty  pounds,  weighing  107 
when  first  seen.  She  had  been  examined 
by  a  surgeon  two  weeks  before,  coming 
from  Maine  and  pronounced  to  have  inop- 
erable uterine  cancer.  She  was  examined 
here,  by  a  gynaecologist,  who  found  ex- 
tensive cauliflour  ulceration  of  the  cervix, 
with  the  uterus  of  great  size.  She  had 
had  six  children,  38  to  28  years  of  age, 
and  the  menses  has  ceased  twenty  years 
ago.  She  was  always  constipated,  the 
urine  had  always  been  scanty,  and  the 
saliva  was  very  acid.  The  urine  was  of 
low  specific  gravity,  contained  a  moderate 
amount  of  albumen,  and  the  urea  low. 
Under  careful  dietetic  and  medical  treat- 
ment, with  the  same  vaginal  douche  as  in 
the  preceding  case,  she  improved  greatly, 
gained  two  pounds  and  a  half  in  weight, 
and  *^felt  like  a  different  person,''  within 
a  month,  coming  frequently  to  the  office. 


358  MEDICAL  ASPECTS  OF  CANCER 

She  had  relatively  little  pain,  never  re- 
quiring an  opiate,  and  two  months  from 
the  first  it  was  recorded  that  she  ^'felt 
freer  from  pain  during  the  preceding  week 
than  for  weeks  or  months."  The  douche 
came  clear,  and  without  blood.  The  urine 
continued  of  low  specific  gravity,  but  oc- 
casionally without  albumen,  and  the  saliva 
continued  very  acid.  Two  weeks  later  she 
had  a  strange  attack,  with  suppression  of 
urine,  and  she  became  somewhat  irrational, 
and  was  moved  to  the  hospital,  as  she 
could  not  be  well  cared  for  in  a  boarding 
house.  This  condition  continued  for  a 
while,  but  two  weeks  later  she  was  per- 
fectly rational  and  wanted  to  go  to  her 
home  in  Maine;  she  said  that  she  had  no 
pain.  She  was  taken  home  and  died  peace- 
fully 25  hours  after  reaching  there,  on 
March  21st,  1918.  She  thus  lived  almost 
four  months  in  comparative  comfort;  not 
taking  a  particle  of  morphine  or  other 
hypnotic,  and  died  without  pain,  sleeping 
peacefully,    as    reported   by    letter.     The 


CONCLUSIONS  AND  EESULTS  359 

case  was  of  course  hopeless  from  the  be- 
ginning. 

Cancer  of  the  stomach.  Five  cases 
were  recorded,  all  males,  aged  65,  58,  56, 
44,  and  43,  but  only  one  of  them  is  report- 
ed; one  was  seen  only  once  in  consulta- 
tion, far  advanced,  who  died  not  long 
afterwards. 

Case  XI:  W.  B.,  aged  56,  had  been 
sickly  and  not  working  for  a  year  before 
his  first  visit,  August  30,  1916,  and  had 
seen  many  physicians  and  surgeons,  all 
of  whom  diagnosed  the  trouble  as  cancer 
of  the  stomach.  He  had  had  pain  in  the 
epigastrium  for  a  long  time,  with  swelling 
and  hardness.  On  examination  there  was 
dullness  on  percussion  over  the  pyloric 
region,  and  a  mass  could  be  felt.  He  had 
chronic  constipation  with  coated  tongue, 
and  was  very  weak,  having  lost  many 
pounds.  Placed  on  a  rigid  diet  and  strict 
regulations  as  to  mastication  and  living, 
with  medication,  he  improved  greatly, 
looking  and  feeling  much  better  at  the 


360  MEDICAL  ASPECTS  OF  CANCER 

the  few  visits  he  made  from  another  city. 
Seven  months  later  I  learned  from  his 
brother-in-law,  who  had  brought  him,  that 
the  patient  was  very  well,  and  was  work- 
ing again.  I  realize  that  the  diagnosis  is 
very  difficult  in  these  cases,  and  that  he 
may  not  have  had  real  cancer,  but  his 
whole  appearance  and  the  clinical  symp- 
toms, with  his  cancerous  cachexia,  loss  of 
weight,  etc.,  indicated  the  probable  cor- 
rectness of  the  diagnosis  made  by  several 
medical  men,  and  the  results  certainly 
were   most   satisfactory. 

Cancer  of  the  rechcm.  Two  cases  were 
recorded,  one  a  woman  aged  55  and  a  man 
aged  42,  the  latter  only  being  treated. 
The  former  had  had  an  artificial  anus 
made,  and  subsequently  intestinal  anas- 
tomosis for  inoperable  cancer  of  the  rec- 
tum, and  was  seen  only  once. 

Case  XII:  Mr.  R.  G.,  aged  42,  came 
for  treatment  June  13,  1917.  Two  and  a 
half  years  before  he  had  had  an  operation 
for  ulcer  of  the  stomach,  and  had  had  no 


CONCLUSIONS  AND  EESULTS  361 

trouble  until  November,  1916,  when  he  was 
given  Eussian  oil  for  obstinate  constipa- 
tion. About  a  month  before  his  visit  he 
was  seen  by  a  surgeon  of  prominence, 
who  diagnosed  cancer  of  the  rectum,  veri- 
fied by  microscopic  findings,  and  advised 
an  operation,  which  he  refused.  When 
seen  he  was  rather  thin  and  haggard,  hav- 
ing lost  a  good  many  pounds,  pulse  92 
and  poor,  tongue  badly  coated.  His  sleep 
was  disturbed  by  having  to  get  up  three 
or  four  times  for  small  thready,  bowel 
movements,  of  which  he  had  from  twelve 
to  fifteen  in  the  24  hours.  On  examina- 
tion there  were  no  external  signs  of  dis- 
ease, and  digital  examination  revealed 
little,  the  disease  being  higher  up.  Under 
dietary  and  other  treatment  the  bowel 
movements  were  soon  reduced  to  four  in 
the  twenty-four  hours,  one  of  them  at 
night,  but  still  watery  and  generally  with 
some  blood,  but  no  pain.  Six  months 
later  he  was  having  often  formed  move- 
ments of  good  size  and  had  been  better 


362  MEDICAL  ASPECTS  OF  CANCER 

in  every  way  the  preceding  month  than 
for  a  year,  with  only  slight  pain  in  the 
rectum  occasionally:  there  was  still  a 
little  blood  passed,  although  on  April  12th, 
after  an  absence  of  a  month,  it  was  re- 
corded that  there  was  no  blood  in  the 
passage.  When  last  seen,  nearly  a  year 
from  the  first,  he  was  in  about  the  same 
condition,  he  had  been  steadily  at  work 
in  a  dry  goods  house  all  the  time  while 
under  treatment.  In  view  of  the  unsat- 
isfactory results  commonly  obtained  by 
operation  and  the  distressing  condition  of 
a  patient  after  colostomy,  the  results  in 
this  case  may  be  considered  satisfactory. 

Cancer  of  the  prostate.  Two  cases 
were  seen,  aged  74  and  54;  one  was  seen 
only  once. 

Case  XII :  B.  S.,  aged  54,  had  long  had 
enlarged  prostate,  with  frequent  urination 
day  and  night.  He  had  lost  flesh,  es- 
pecially during  the  six  months  preceding 
his  first  visit,  October  26th,  1917.  He  had 
then  an   earthy,  cachectic  look,  was  thin 


CONCLUSIONS  AND  EESULTS  363 

and  depressed.  On  examination  by  a  sur- 
geon the  prostate  was  found  enlarged  and 
the  inguinal  glands  on  both  sides  were 
greatly  affected,  forming  great  masses  vis- 
ible to  the  eye,  there  being  no  lesions  on 
the  penis.  Under  the  '^ green  card*'  diet 
and  medication  there  was  a  great  change 
in  a  few  weeks.  The  patient  felt  and 
looked  much  better.  The  glands  in  the 
groins  had  subsided  greatly,  and  shortly 
thereafter  they  had  quite  disappeared,  the 
cachexia  was  gone,  and  he  had  not  an  ache 
or  a  pain.  He  was  lost  sight  of;  and  al- 
though written  to  did  not  respond,  but  I 
learned  by  the  daily  paper  that  he  died 
suddenly.  As  in  cancer  of  the  stomach  a 
clinical  diagnosis  is  often  difficult,  but 
such  a  result  of  the  treatment  was  cer- 
tainly satisfactory  and  preferable  to  surg- 
ical interference,  with  all  its  uncertainties. 
Cancer  of  the  kidney.  One  case  has 
been  under  my  constant  care  for  two 
years  and  the  results  illustrate  well  the 
value    of    continued    internal    treatment. 


364  MEDICAL  ASPECTS  OF  CANCER 

Case  XIV:  Mr.  H.  H.  B.,  aged  55,  had 
been  indisposed  for  a  year,  his  color  was 
bad,  and  work  difficult  to  accomplish.  On 
August  25th,  1916,  he  passed  blood  in  the 
urine,  and  the  next  day  red  blood,  and 
also  coagulated,  with  much  pain  in  the 
back.  The  x-trj  was  said  to  show  noth- 
ing, nor  cystocopy,  except  blood  from  the 
right  kidney.  This  latter  was  removed 
on  September  1st,  in  another  city,  and 
found  to  be  enlarged  four  times  in  size, 
weighing  over  two  pounds,  and  shown  to 
be  cancerous  miscroscopically.  He  made 
a  good  recovery,  and  had  no  pain  while 
in  bed,  three  weeks,  but  on  walking  had 
pain  in  the  left  side,  increasing  toward 
afternoon  and  rendering  life  miserable  up 
to  his  coming  under  treatment  January 
30th,  1917.  The  pain  generally  ceased  on 
lying  down  at  night.  He  weighed  173% 
pounds,  and  was  a  large  eater  of  meat 
and  very  fond  of  milk  and  eggs;  he  had 
never  had  any  restriction  of  diet,  nor  di- 
rections or  other  treatment  of  any  kind. 


CONCLUSIONS  AND  RESULTS  365 

Under  strict  vegetarian  diet  and  varied 
treatment  at  frequent  consultations,  with 
voluminous  notes,  he  has  for  two  years 
been  able  to  do  his  work,  has  gained  I41/2 
pounds  in  weight,  and  for  long  periods 
has  been  free  from  pain,  although  there 
are  times  when  he  has  pain  over  the 
left  kidney.  Recent  notes  show  that  he 
was  ** doing  normal  work''  and  ** stands 
well  the  hardest  strain,"  **felt  better  than 
for  years"  and  ^^ never  had  so  good  a  color 
or  circulation."  The  urine  has  been 
watched,  measured  daily  all  the  time, 
and  frequently  analyzed  volumetrically  and 
has  commonly  averaged  over  50  ounces 
daily;  the  various  ingredients  are  gen- 
erally about  normal,  except  that  the  urea 
is  low,  owing  to  the  vegetarian  diet.  He 
has  been,  and  I  believe  will  be  very  faith- 
ful to  treatment,  which  has  certainly  pro- 
longed his  life  and  usefulness,  and  given 
great  comfort  and  ease.  How  long  it 
will  be  necessary  to  continue  active  treat- 
ment it  is  difficult  to  say;  a  relapse  to 


366  MEDICAL  ASPECTS  OF  CANCER 

his  former  method  of  living  and  entire 
neglect  of  protective  treatment  might 
naturally  be  expected  to  again  induce  a 
serious  involvement  of  the  remaining  kid- 
ney. He  has,  of  course,  never  take  a  par- 
ticle of  morphine  or  other  hypnotic,  the 
pains  occurring  at  times  being  largely  re- 
lieved by  the  frequent  use  of  aspirin. 

Cancer  of  the  bladder.  One  case  of  this 
has  been  under  prolonged  treatment  with 
eminently  satisfactory  results. 

Case  XV:  Mr.  G.  W.  H.,  aged  68,  had 
been  under  my  care  for  a  number  of  years, 
for  various  difficulties,  when  on  March 
27th,  1914,  he  brought  two  specimens  of 
urine  with  clots  of  blood  and  a  consider- 
able amount  of  albumen  in  the  evening 
sample,  and  was  seen  the  next  day. 
There  had  been  no  especial  pain  in  the 
back,  nor  on  passing  urine,  which  had 
cleared  since.  Three  days  later  he  was 
again  passing  blood  and  was  feeling  weak, 
and  thought  he  had  lost  two  pounds  in 
weight.    He    had    to    urinate    every    two 


CONCLUSIONS  AND  RESULTS  367 

hours,  twice  at  night;  the  blood  appeared 
mainly  at  the  end  of  the  urination.  Blood 
pressure  160,  systolic.  On  April  2nd  he 
was  cystoscoped  by  Dr.  A.  R.  Stevens. 
The  bladder  muscosa  was  found  to  be 
normal  except  near  the  left  urethral  ori- 
fice. Just  above  this  there  was  a  small 
nodular,  well  defined,  sessile  mass,  with 
small  blood  vessels  over  its  surface,  pretty 
typical  of  carcinoma  of  the  bladder  wall. 
Radical  excision  was  advised,  or  else  ful- 
guration.  Declining  these  very  positively 
he  was  treated  medically  for  a  month, 
when  he  yielded  and  on  May  7th  Dr. 
Stevens  treated  the  lesion  by  fulguration, 
which  was  repeated  on  May  22nd.  On 
August  5th,  there  was  some  recurrence 
seen,  in  a  slight  crescentic  mass,  which 
was  destroyed  by  high  frequency  current, 
with  again  a  slight  operation  on  August 
10th.  On  October  22nd  he  was  cysto- 
scoped and  no  sign  of  recurrence  was  seen, 
only  a  scar.  On  February  23rd,  1916, 
there  was  a  small  regrowth,  not  one-half 


368  MEDICAL  ASPECTS  OF  CANCER 

the  former  size,  which  was  treated  with  the 
high  frequency  current,  and  again  slight- 
ly on  March  2nd.  He  has  been  repeatedly 
cystoscoped  since  that  date,  up  to  the 
present  time,  by  three  urologists,  and 
there  are  no  signs  of  recurrence  now 
nearly  five  years  from  the  first  symp- 
toms observed. 

The  patient  has  been  under  constant 
medical  treatment,  with  strict  diet  all 
this  time,  for  various  troubles  attending 
high  blood  pressure  which  has  reached 
200  systolic,  but  is  commonly  kept  under 
control  to  about  150  systolic  and  80  dias- 
tolic. On  December  22nd,  1916,  Dr.  Stevens 
found  a  ^ 'large,  elastic  prostate  (not 
carcinoma),''  which,  however,  seemed  to 
cause  no  special  symptoms  until  Decem- 
ber 7th,  1917,  when  blood  clots  were  found 
in  the  urine,  which  have  continued  to  ap- 
pear much  of  the  time  ever  since;  these 
clots  show  only  blood  and  fibrin,  and  no 
evidence  of  new  growth  tissue  as  report- 
ed by  Dr.  Jessup.    On  repeated  cystoscopic 


CONCLUSIONS  AND  RESULTS  369 

examinations  no  trace  of  the  original 
or  any  other  trouble  in  the  bladder  has 
been  found,  but  ''an  adenomatous  hy- 
pertrophy of  the  prostate  and  a  slight 
bleeding  from  the  prostatic  portion  of  the 
urethra. ''  This  was  confirmed  by  two 
other  urologists.  During  all  this  time 
under  strict  regimen  and  varied  medica- 
tion he  has  maintained  his  usual  health, 
color,  and  weight,  and  pursued  his  usual 
business. 

Cancer  of  the  buccal  cavity.  Five 
cases  were  observed,  four  males,  aged 
47,  48,  59,  and  72,  and  one  female  aged 
44:  of  these  two  were  of  the  right  upper 
jaw  (not  sarcoma),  two  of  the  tongue  and 
one  of  the  tonsil;  there  were  also  three 
cases  of  sarcoma,  two  of  the  left  upper 
jaw  and  one  of  the  right  lower  jaw,  be- 
sides two  other  cases  of  sarcoma  located 
elsewhere.  The  cases  of  carcinoma  of 
the  jaw  were  seen  only  in  consultation, 
one  was  a  terrific  post-operative  case  for 
which   little   or   nothing    could   be   done. 


370  MEDICAL  ASPECTS  OF  CANCER 

The  sarcoma  cases  were  also  seen  in  con- 
sultation, and  one  was  advised  to  see  Dr. 
Janeway,  for  radium  treatment.  The  fe- 
male with  cancer  of  the  tongue  was  seen 
once  in  consultation,  the  other  case, 
though  rather  recent,  and  also  the  one 
with  cancer  of  the  tonsil  are  worthy  of 
mention. 

Case  XVI:  Mr.  K.  M.  A.,  aged  59,  seen 
September  11th,  1918,  first  noticed  an  ir- 
ritation of  the  right  side  of  the  tongue, 
from  a  broken  tooth,  in  May,  and  on  May 
11th,  it  was  operated  on  with  a  knife  and 
healed  so  that  he  went  to  work  on  May 
20th,  with  no  pain  for  three  weeks.  It 
then  began  to  ulcerate  and  a  knife  was 
again  used  and  it  was  cauterized  on 
August  5th,  and  he  left  the  hospital  August 
11th,  five  weeks  before  his  visit;  since 
that  time  the  trouble  has  been  increasing 
rapidly,  until  when  first  seen  the  tongue 
was  enormous,  filling  the  buccal  cavity, 
with  a  large  ulcerative,  hard  patch,  an 
inch  and  more  on  the  side  with  sharp,  hard 


CONCLUSIONS  AND  RESULTS  371 

edges:  the  submaxillary  glands  were  very 
large,  hard,  and  matted  together,  and  the 
case  was  considered  wholly  inoperable  by 
the  surgeons  whom  he  had  seen.  He  had 
always  smoked  much,  but  took  little  al- 
cohol, coiTee  or  tea.  The  saliva  was  very 
acid,  the  urine  contained  much  indican, 
also  oxalates  and  phosphates. 

Being  placed  on  the  green  card  diet, 
with  absolutely  no  smoking,  alcohol,  coffee 
or  tea,  and  with  the  mixture  of  acetate  of 
potassa,  nux  vomica,  cascara,  and  extract 
of  rumex,  the  improvement  began  almost 
at  once.  He  also  used  a  mouth  wash  of 
a  saturated  solution  of  bicarbonate  of 
soda,  diluted  one-half,  held  in  the  mouth 
some  minutes,  a  quarter  of  an  hour  be- 
fore and  also  after  taking  food.  He  could 
take  only  liquid  food,  having  great  diffi- 
culty in  swallowing. 

By  the  end  of  three  months  the  change 
was  most  remarkable.  The  ulceration 
had  ceased  at  the  side  of  the  tongue  which 
had   greatly   diminished   in    size,    though 


372  MEDICAL  ASPECTS  OF  CANCER 

still  hard.  He  swallowed  much  better, 
the  jaws  opened  much  wider  and  he  could 
chew  some,  and  the  glands  beneath  the 
jaw  were  smaller  and  less  adherent  and 
movable,  as  was  verified  by  two  physi- 
cians. He  remarked  the  ^' great  improve- 
ment" in  his  condition  and  his  wife  said 
*  ^  the  change  from  the  first  is  marvellous. ' ' 
He  still  complained  of  some  pain  in  the 
neck,  running  up  to  the  head,  but  he  has 
never  taken  any  morphine  or  anodyne. 
When  seen  later,  very  recently,  the  im- 
provement was  still  more  marked.  It  is, 
of  course,  too  early  to  claim  a  cure,  but 
with  continued  proper  treatment,  of  vari- 
ous kinds,  there  is  every  reason  to  be- 
lieve that  the  progress  toward  that  end 
will  continue.  This  case  illustrates  well 
the  harm  from  curetting  and  cauteriza- 
tion, which  stimulated  an  ordinarily  slight 
ulcerative  process  from  a  rough  tooth  into 
a  malignant  disease. 

Case  XVII:    Mr.  F.  F.,  aged  72,  came 
under  observation  and  treatment  on  Octo- 


CONCLUSIONS  AND  EESULTS  373 

ber  2nd,  1918.  For  three  months  he  had 
felt  a  pressure  of  something  wrong  on 
the  right  side  of  the  throat,  and  on  Sep- 
tember 3rd,  had  had  some  sort  of  an  op- 
eration from  within,  the  nature  of  which 
could  not  be  determined.  He  had  seen 
many  physicians  and  surgeons  who  ad- 
vised a  complete  operation  from  the  out- 
side, which  was  refused.  Wassermann  had 
been  taken  and  found  negative.  On  ex- 
amination the  right  tonsil  was  found  to 
be  the  seat  of  an  ulcerative  process,  half 
an  inch  or  more  in  diameter,  very  hard 
to  the  feel,  with  sharply  defined  hard 
edges,  and  considerable  inflammatory  ac- 
tion of  the  surrounding  parts,  reaching 
over  almost  to  the  left  tonsil.  The  glands 
beneath  the  right  jaw  were  greatly  en- 
larged, the  size  of  a  large  walnut,  but 
rather  movable.  The  saliva  was  very 
acid.  He  had  been  in  the  habit  of  taking 
beer  twice  daily,  and  smoking,  which,  of 
course,  were  stopped.  Placed  on  a  rigid 
vegetarian  diet,  with  the  same  mixture  as 


374  MEDICAL  ASPECTS  OF  CANCER 

in  many  other  cases,  and  the  soda  gargle, 
held  in  the  throat  a  good  while  before 
and  after  each  meal,  he  began  to  improve 
from  the  first.  Within  two  months  the  ul- 
ceration had  about  ceased  and  much  of  the 
adjoining  inflammatory  action  subsided. 
The  hardness  had  largely  disappeared, 
though  the  edge  was  still  hard.  He  re- 
marked, ''I  feel  all  right  and  have  noth- 
ing to  complain  of."  The  gland  in  the 
neck  had  diminished  to  the  size  of  a 
small  almond.  A  little  later  it  was  re- 
corded that  there  was  still  slight  mar- 
ginal hardness,  but  superficial,  in  the  dis- 
eased area,  the  gland  was  still  smaller 
and  freely  movable,  and  he  said  that  he 
felt  ^^ perfectly  well,"  ''find  no  complaint 
of  any  kind." 

Cancer  of  the  lip.  Many  cases  of  can- 
cer of  the  lip  have  been  under  observation 
during  past  years,  varying  gently  in  their 
severity.  Excision  has  been  advised  and 
practiced  in  a  considerable  number,  and 
certain   earlier   cases   have   been   treated 


CONCLUSIONS  AND  RESULTS  375 

medically  with  perfect  success.  I  have 
never  felt  that  the  x-vaj  was  to  be  relied 
on,  though  good  results  have  been  re- 
ported from  this  and  from  radium,  but 
the  percentage  of  even  apparent  cures  is 
not  very  large,  nor  ultimate  results  ob- 
served over  a  long  period.  In  certain  rel- 
atively small  lesions  of  cancer  of  the  lip 
careful  medical  treatment,  accurately  car- 
ried out  long  enough,  is  certainly  capable 
of  producing  a  clinical  cure,  as  I  have  re- 
peatedly observed.  For  the  trouble  is 
really  a  local  affair,  due  to  prolonged  irri- 
tation of  the  mucous  membrane,  in  those 
subject  to  certain  constitutional  condi- 
tions, and  the  altered  tissue  resumes  its 
normal  condition  when  properly  handled, 
and  the  cancerous  proclivity  overcome. 

Of  32  cases,  some  dating  back  10  years 
or  more,  9  at  least  were  clinically  cured, 
and  many  others  so  greatly  improved 
when  last  seen  that  the  ultimate  result 
was  probably  good.  One  man,  a  butcher, 
eating  very  much  meat,  and  weighing  215 


376  MEDICAL  ASPECTS  OF  CANCER 

pounds,  had  a  very  characteristic  epitheli- 
oma, about  %  inch  long  on  the  right  side 
of  the  lower  lip,  existing  about  a  year.  In 
six  months  it  was  absolutely  well,  and  a 
year  or  so  afterward  when  another  patient 
looked  him  up  he  had  forgotten  even  the 
location  of  the  trouble.  A  single  case  may 
be  reported  more  in  full. 

Case  XVIII:  Mr.  W.  H.  N.,  an  unu- 
sually intelligent  gentleman,  aged  45,  from 
a  distant  city,  had  a  slowly  growing  epi- 
thelioma of  the  lower  lip  for  several 
months,  for  which  an  immediate  radical 
opration  was  insisted  on  by  several  prom- 
inent surgeons  and  friends. 

When  first  seen,  Feb.  6th,  1917,  there 
was  an  oval  epitheliomatous  lesion,  just 
to  the  left  of  the  median  line,  about  half 
an  inch  in  diameter,  and  raised  a  line  or 
so.  He  was  placed  on  a  rigid  **  green 
card''  diet,  with  no  smoking,  liquor  or 
beer.  The  surface  was  kept  covered,  night 
and  day,  with  an  ointment  ( 1?  Ichthyol  5ss 
Zinci    Cleat    Sss    Unquent.    Aquae    RosaB 


CONCLUSIONS  AND  RESULTS  377 

31),  spread  on  the  thinnest  possible  por- 
tion of  absorbent  cotton,  which  adhered 
perfectly  over  the  lesion.  This  was  re- 
placed twice  a  day  or  oftener.  In  a  week 
there  was  a  decided  change,  the  mass 
being  much  softer,  though  with  still  de- 
cided induration.  The  ointment  was 
changed  from  time  to  time,  with  occa- 
sionally one  per  cent,  of  powdered  sali- 
cylic or  pyrogallic  acid  added,  reverting 
at  times  to  the  first  ointment,  when  these 
seemed  a  trifle  irritating.  Nine  months 
later  he  kindly  presented  himself  at  my 
lecture  at  the  New  York  Skin  and  Cancer 
Hospital,  and  himself  gave  the  physicians 
present  a  remarkable  lecture  on  the  dis- 
ease and  its  treatment,  stating  that  he  was 
a  Harvard  graduate,  and  had  studied 
medicine  a  while,  and  knew  what  he  was 
talking  about,  urging  them  seriously  to 
carry  out  this  treatment.  A  year  later 
he  wrote  enthusiastically  about  his  case. 
The  secret  of  success  lies  in  the  absolute 
protection  of  the  diseased  surface,  night 


378  MEDICAL  ASPECTS  OF  CANCER 

and  day,  with  the  closely  applied  soothing 
and  alterative  ointment,  spread  thickly  on 
the  thinnest  possible  layer  of  absorbent 
cotton,  pressed  closely  on;  this,  of  course, 
is  accompanied  with  other  proper  general 
treatment  for  the  cancerous  state. 

In  this  and  the  preceding  volumes  are 
recorded  over  thirty  cases  of  cancer,  from 
among  many  others,  in  which  the  benefit 
of  a  properly  regulated  medical  treat- 
ment was  clearly  manifest.  Some  of  the 
earlier  breast  cases  had  been  followed 
from  13  to  16  years,  remaining  perfectly 
well  without  operation;  others  well  from 
three  to  five  years;  and  the  two  uterine 
cases,  reported  in  the  second  volume  re- 
main well  for  almost  three  years,  with  no 
recurrence,  being  still  under  treatment. 
The  more  recent  cases  have  showed  such 
steady  improvement  that  it  can  hardly  be 
doubted  but  that,  if  they  remain  still 
faithful  to  treatment,  they  will  ultimately 
recover.     The    fatal    cases    were    mostly 


CONCLUSIONS  AND  RESULTS  379 

post-operative,  but  they  also  exhibited 
strikingly  the  benefits  from  this  treat- 
ment, in  prolongation  of  life  and  great 
comfort.  As  far  as  I  can  learn  from  my 
notes  none  of  the  patients  required  or  re- 
ceived any  anodyne,  from  soon  after  the 
time  that  they  began  treatment.  When 
all  this  compared  with  the  ordinary  course 
of  cancer  cases  it  does  seem  that  we  are  on 
the  right  track  concerning  the  treatment 
of  cancer. 

It  is  not  claimed  that  the  goal  has  been 
reached,  or  that  the  details  of  this  line 
of  treatment  are  complete.  Laboratory 
and  clinical  study  on  the  blood  plasma,  as 
well  as  on  the  secretions  and  excretions 
will  undoubtedly  elaborate  more  perfectly 
the  best  plan  of  dietary  and  other  treat- 
ment, and  as  other  observers  follow  this 
plan  of  treatment  there  will  doubtless  be 
found  a  gradual  reduction  in  the  mortali- 
ty of  cancer,  greater  even  than  has  oc- 
curred in  New  York  City  during  1918.    It 


380  MEDICAL  ASPECTS  OF  CANCER 

is  surely  to  be  hoped  that  as  **The  real 
Cancer  Problem''  is  fully  solved  there 
will  be,  under  proper  constitutional  treat- 
ment, the  same  lowering  of  mortality  that 
has  occurred  in  tuberculosis  under  wise 
medical  treatment.  And  as  correct  views 
of  living  prevail  the  morbidity  of  cancer 
will  decrease  with  its  mortality. 


INDEX 


Abernethy  on  a  constitu- 
tional cause  of  can- 
cer, 62 

Aborigines,  cancer  rare 
in,  35,  67,  233,  279 

Acidity  of  saliva  in  can- 
cer,  96,  228,   305 

Adenoma,  removal  of,  fol- 
lowed by  cancer, 
114 

Aebli  on  untreated  can- 
cer, 235 

Alcohol,  influence  on  can- 
cer, 88 

Australia,  cancer  in,  279 

Belgium,   cancer  in,  283 
Bio-chemistry    of    cancer, 

203 
Bladder,    cancer    of    the, 

365 
Blood,  changes  in  cancer, 

92,    170,    204,    225, 

267 
Bowels,  elimination  from, 

in  cancer,  110,  164, 

178,  270 
Breast,     cancer    of.    115, 

327,  338 
Buccal  cavity,  cancer  of, 

289,   300,   368 
Butter,  value  in   cancer, 

176 

Cancer  and  body  elimina- 
tion,  262 
and     civilization,     128, 
200,  276 


and  coffee,  89,  233 
Cancer  and  diet,  33,  35,  40, 

76,  121,  144,  150,  201, 

239 
and  heredity,  219 
and  lymphatics.  205 
and  meat.  88,  128,  146, 

232,  258 
and  metabolism,  32,  91, 

205 
and  metastasis,  205 
and  nutrition,  202,  314, 

325 
and  occupation,  287 
and  the  medical  practi- 
tioner, 307 
and  tuberculosis,  26,  34, 

59.  284,  285 
as    a   non-surgical    dis- 
ease, 25 
bio-chemistry  of,  203 
caused     by     intestinal 

stasis,  111,  164,  178, 

270 
changes  in  the  blood  in, 

92.    170,    204,    225, 

267 
clinical  findings  in,  190 
constipation,  cause  of, 

111,  164,  178,  270 
constitutional       nature 

of,  18 
cure  of,  medically,  336 
cures,  64 
death  rate  compared  to 

tuberculosis,  26,  34, 

284 


382 


INDEX 


Cancer,  death  rate  in  1917, 
in  New  York  City,  41 

death  rate  in  1918,  in 
New  York  City,  49 

death  rate  of,  in  the 
world,  81 

derangement  of  liver  in, 
272 

dietetic  treatment  of, 
144,  151 

diet  most  Important 
in,  239 

due  to  faulty  metab- 
olism, 33 

early,  health  of  patients 
with,  224 

early  medical  treat- 
ment of,  319 

ethnological  relation  of, 
200 

families,  220 

from  a  medical  stand- 
point, 53 

genetic  changes  in  cells, 
316 

geographical  relations 
of,  200 

harm  from  nitrate  of 
silver,  304 

in  Australia,  279 

in  Belgium,  283 

in  England,  282 

in  France,  283 

in  Germany,  283 

in  Holland,  283 

in  Italy,  284 

influence  of  alcohol  on, 
88 

influence  of  coffee  on, 
89,  233 


Cancer,   inftuence   of  meat 
on,  88,  146,  232,  258 

intestinal  stasis  cause 
of  111,  164,  178, 
270 

juice,  268 

laboratory  findings, 

negative,  29,  185 
positive,  31,  187 

malignant  hormone  se- 
creted by,  267 

meat  eating  cause  of, 
88,  146,  232,  258 

medical   aspects   of,   71 
treatment      of,      144, 
211,  242 

nitrogen  partition  in, 
228 

non-surgical  treatment 
of,  169 

nosological  relations  of, 
198 

not  altogether  a  dis- 
ease of  old  age,  30 

not  a  surgical  disease, 
25 

not  contagious,  29 

not  from  occupation,  30 

not  hereditary,  29 

not  parasitic,  29 

not  wholly  due  to  local 
injury,  29 

of  the  bladder,  366 

of  the  breast,  115,  327, 
338 

of  the  buccal  cavity, 
288,  369 

of  the  kidney,  363 

of  the  lip,  374 


INDEX 


Cancer  of  the  prostate,  362 
of  the  rectum,  360 
of  the  stomach,  359 
of  the  tonsil,  372 
of  the  uterus,  334,  353 
only     the     product     of 

previous      systemic 

disease,    126 
pathology,  teachings  of, 

181 
patience     i  n     medical 

treatment   of,   238 
perseverance  in  medical 

treatment   of,   238 
problem  not  fully  solved 

yet,   322 
prophylaxis  of,  72,  102, 

106,  161,  236,  252 
product     of     metabolic 

error,  181 
rarity  of,  in  aborigines, 

35,  67,  233,  279 
rarity  of  in  vegetarian 

countries,  130,  234, 

281 
results  of  medical  treat- 
ment, 321 
rice  inhibiting,  231 
saliva  acid  in  96,  228, 

305 
skin    elimination    in, 

273 
study  of  patients  with, 

208 
surgical  aspects  of,  74, 

309 
time  of  cure  of,  311 
ultimate      death      rate 

from,  25,  54 
untreated,  235 


Cancer,   urine   in,   94,    111, 
165,  177,  227,  269 
vegetarian  diet  in,  121, 

151,  161 
report  of,  115,  327,  339 

Chart  of  cancer  death 
rate,   58 

Civilization  and  cancer, 
201,  276 

Clinical  findings  in  can- 
cer, 190,  286 

Coffee,  influence  in  can- 
cer, 89,  233 

Cohnheim,  embryonic 
rests,  216 

Conclusions  and  results, 
321 

Constipation  a  cause  of 
cancer,  111,  164, 
178,  270 

Constitutional  nature  of 
cancer,  18,  210,  229 

Contagious,  cancer  is  not, 
29 

Cooper,  Astley,  on  intesti- 
nal cause  of  cancer, 
79 

Cure  of  cancer,  medically, 
336 
teachings  of  pathology, 

181 
time  of,  311 

Death   rate  of  cancer  in 

1917,      New     York 

City,  41 
of  cancer  in  1918,  New 

ork  City,  49 
of  cancer  in  the  United 

States,  chart,  58 


384 


INDEX 


Death  rate  of  cancer  in  the 
world,  81 
ultimate,   from   cancer 
25,  54 
Diet  and   cancer,   33,  35, 
40,     76,     121,     144, 
150,  201,  239 
and  growth,   230 
effect  in  cancer,  33,  35, 
40,    121,    144,    150, 
201,  239 
Dietetic  treatment  of  can- 
cer, 144 
Diet  for  cancer,  151 
most  important  in  can- 
cer, 239 
relation  to  cancer,  121 

Early    medical   treatment 

of  cancer,  319 
Elimination    and    cancer, 

262 
Embryonic  rests,  126,  216 
End  results  in  cancer,  54 
England,  cancer  in,  282 
Ethnological  relations   of 

cancer,  200 
Epithelioma,    death    rate 

of,  27,  196 

Far  East,  rarity  of  cancer 

in,  234,  281 
France,  cancer  in,  283 

Geographical  relations  of 

cancer,   200 
Germany,   cancer  in,   283 

Health   of  patients   with 
early  cancer,  224 


Heredity,  insignificant  in 

cancer,  29,  219 
Holland,  cancer  in,  283 
Hormone,    malignant,    se- 
creted   by    cancer, 
33,  160,  267 

Ignored,   evidence  cannot 

be,  323 
Indians,  rarity  of  cancer 

in,  279 
Intestinal  stasis,  cause  of 

cancer.     111,     164, 

178,  270 
Italy,  cancer  in,  284 

Kidney,  cancer  of,  363 

Laboratory  findings  nega- 
tive in  cancer,  29, 
185 

Lambe  on  internal  cause 
of  cancer,  77 

Lane,  Sir  Arbuthnot,  on 
intestinal  stasis 
cause  of  cancer,  111 

Lip,  cancer  of  the,  374 

Liver,  derangement  of,  in 
cancer,  272 

Lymphatics  and  cancer, 
205 

Mayo,  W.  J.,  prophylaxis 
of  cancer,  252 
on    internal    cause    of 
cancer,  71,  229 
Meat  and  cancer,  88,  128, 
146,  232,  258 
not   the  only   cause  of 
cancer,   258 


INDEX 


385 


Medical  aspects  of  cancer, 
74 
standpoint  of  cancer.  53 
treatment,    cases    illus- 
trative of,  115,  327, 
339 
treatment  of  cancer,  re- 
sults of,  321 
practitioner  and  cancer, 
307 

Medicinal  treatment  of 
cancer,  144,  211, 
242 

Metabolism  and  cancer, 
32,  205 

Metastasis  and  cancer, 
205 

Mexico,   rarity  of  cancer 
in.  280 

Morbid  tissue  growth.  222 

Mouth,  cancer  of,  2S9 

Murphy,  John  B..  pessi- 
mism   of,    252 

Negative  results  of  re- 
search, 29,  30,  185 

Nervous  strain  and  can- 
cer. 90 

New  York  City,  cancer 
death  rate,  in  1917, 
1918,  41,  49 

Nitrate  of  silver,  harm- 
ful  in   cancer,   305 

Nitrogenous  metabolism, 
faulty  in  cancer, 
227,  255 

Normal  tissue  growth, 
221 

Non-surgical  disease,  can- 
cer a,  25 
treatment     of     cancer, 
169 


Nosological  relations  of 
cancer,  198 

Nutrition  and  cancer,  202, 
314,  325 

Occupation,  influence  in 
cancer,  30,  287 

Old  age  and  cancer,  30 

Oral  cavity,  cancer  of, 
289 

Paget,  Sir  James,  on  con- 
stitutional nature 
of  cancer,  79 

Parasitic,  cancer  is  not, 
29 

Parker,  Willard,  on  inter- 
nal cause  of  cancer, 
78 

Pathology,  teachings  of, 
in  cancer,  181 

Patience  in  medical  treat- 
ment of  cancer,  238 

Perseverance  in  medical 
treatment  of  can- 
cer, 238 

Plasma  of  blood,  relation 
of,  to  cancer,  171,  204 

Plea  for  the  rational 
treatment  of  can- 
cer, 15 

Positive  results  of  re- 
search, 31,  187 

Precancerous  conditions, 
248 

Problem,  cancer,  not  ful- 
ly solved  yet,  322 

Product,  cancer,  of  meta 
bolic  error,  182 

Prophylaxis  of  cancer,  72 
102,  106,  161,  236 
252 


386 


INDEX 


Prostate,  cancer  of  the 
362 

Radium  in  cancer,  55,  76, 
209,  303 

Real  cancer  problem,  321 

Rectum,  cancer  of,  360 

Report  of  cases,  115,  327, 
339 

Results  of  medical  treat- 
ment of  cancer, 
244.  321 

Rice  inhibiting  cancer, 
231 

Saliva  acid  in  cancer.  96, 
228,  305 

Sarcoma  of  buccal  cavity, 
301 

Sarcoma  of  jaw,  330 

Serum  therapy  of  cancer, 
109 

SIvin,  elimination  from,  in 
cancer,   273 

Spontaneous  disappear- 
ance of  cancer,  36 

Stasis,  intestinal,  cause  of 
cancer.  111,  164, 
178,  270 

Stomach,    cancer    of.    359 

Study  of  cancer  patients. 
'  157,  208,  238,  241 

Sulphur  partition.  de- 
ranged in  cancer, 
228 

Surgical  aspect  of  cancer, 
54,  74,  309,  318 


Sweat,  elimination  of,  in 

cancer,  273 
Syphilis  of  buccal  cavity, 

297 

Time  of  cure  of  cancer, 
311 

Tonsil,  cancer  of  the,  372 

Traumatic,  cancer  is  not 
wholly,  29 

Treatment,  medical,  of 
cancer,   211 

Tuberculosis,  death  rate 
compared  to  can- 
cer, 26,  34.  59,  284, 
285 

Ultimate    death    rate    of 

cancer,  25.  54 
T'rea  in  cancer.  269 
United     States,     cancer 

death  rate  in,  58 
T>ine  in  cancer.  94.  Ill, 

165.  177.  227,  269 
Uterus,     cancer    of,    334, 

353 

Vegetarian  diet  in  cancer, 
110,  160 

W  a  1  s  h  e.  constitutional 
nature  of  cancer, 
78 

Williams  on  tumor  forma- 
tion, 223 

World,  cancer  death  rate 
in,  81 


University  of  California 

SOUTHERN  REGIONAL  LIBRARY  FACILITY 

405  Hilgard  Avenue,  Los  Angeles,  CA  90024-1388 

Return  this  material  to  the  library 

from  which  it  was  borrowed. 


Bulkley. 
cancer 


QZ  266 
B  93^  m 
1919 
The  medical  treatment  of 


UCI  CCM  LIBRARY 


illlli!! 


Ill 


m 


M 


r 


!il  !l  I 


m\\m 


